New Patient Forms

Thank you for choosing Orange County Physicians' Hearing Services as your hearing healthcare professionals!

To expedite your waiting time, please complete to appropriate forms prior to your appointment.

New Patient (Adult):
Patient Information Facesheet, Medical History, Receipt of Notice of Privacy Practices, and Financial Policies

New Patient with Medicare:
Patient Information Facesheet, Medical History, Receipt of Notice of Privacy Practices, and Assignment of Benefits & Release to Medicare

New Patient (Pediatric):
Pediatric Facesheet, Medical History, Receipt of Notice of Privacy Practices, and Financial Policies 

Returning patients:  Please update facesheet annually or sooner if patient information changes.   

Assignment of Benefits & Release to Medicare

Financial Policies

Medical History 

Patient Information Facesheet

Pediatric Facesheet

Receipt of Notice of Privacy Practices