New Patient Forms

Please bring these 3 completed forms to your 1st appointment with us.

Patient Registration
Medical History
Financial Policy

Other forms that may be helpful during your visit:

Dizziness Questionnaire - If you are coming to see us for dizziness, imbalance, lightheadedness concerns
Head Nose - If you are coming to see us for hearing issues and Tinnitus

Education Forms

Epley Maneuver
Meniere’s disease
Benign paroxysmal positional vertigo (BPPV)
Notice of Privacy Practices - Our HIPAA policy
Request Medical Records
BOTOX and Fillers Procedure - Pre & After Care

For convenience you are welcome to fax your completed forms to us at 804-282-1043. We just ask that you please fax them at least 48 hours prior to your visit.

Post-Operative Instructions

Ear Tube Placement
Tonsillectomy/Adenoidectomy Post Op & Diet Instructions
ALL Ear Surgeries (excluding Ear Tubes)
Neurotologic Patients
Labyrinthectomy and Endolymphatic Sac Surgeries
Cochlear Implants
Nasal Surgery
VIVAER Procedure

Looking for a copy of your medical records?

There is a flat service fee of $15 for us to compile and electronically send your records to your desired location. If you would like to have them printed it would cost the standard $15 service fee and an additional $1 per piece of paper plus the cost of postage. Please complete our Request Medical Records form and send to us. We unfortunately are not able to accept verbal request. Only written request will be honored. For convenience you are welcome to fax your completed forms to us at 804-282-1043 or email the completed form to (not HIPAA complaint). Our goal is to have your request completed within 48 hours, however, due to the heavy schedules our employee and physician work, we can only guarantee a 5-business day turnaround time.



Virginia Hearing Center

Balance and Ear Center

Pediatric Center

Priority Physician Referral

Patient Portal

Pay Online

Office Hours

Monday: 7:30 am - 5:00 pm
Tuesday: 8:30 am - 5:00 pm
Wednesday: 8:30 am - 5:00 pm
Thursday: 8:30 am - 5:00 pm
Friday: 7:30 am - 2:30 pm

Main Phone Line:

Virginia Hearing Center:


Phones turned over to voicemail 30 minutes prior to office closing.

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