Downloadable forms from Champlain Valley Audiology

You may complete the new patient paperwork before your appointment and bring them with you or fax them to (518) 324-5726, or scan them to Please plan to arrive at least 15 minutes prior to your appointment to review any other necessary New Patient information.

  • For adult hearing testing: Adult Patient Forms
  • For pediatric hearing testing: Child Patient Forms
  • For tinnitus concerns: Adult Forms and Tinnitus Patient Forms
  • For hearing aid evaluation: Adult or Child Forms and Companion Questionnaire
Adult Patient FormsDownload
Child Patient FormsDownload
Companion QuestionaireDownload
Tinnitus Patient FormsDownload
Waiver of Non-Coverage for TinnitusDownload