About Us Physicians Diagnosis and Treatment Testing Audiology Testing Chicago Dizziness and Hearing Home Physical therapy
  Address
645 N Michigan
Suite 410
Chicago IL
USA 60611
  Phone
312-274-0197
  Fax
312-376-8707
  Email  

Medical Forms

We will ask you to fill out a 9 page questionnaire, and supply insurance information. It is recommended that you bring it in yourself already filled out. This may also save some time. Please fill out one of the following questionnaires.

If you would like to have information sent to us from your doctor, please fill out the records release form (pdf format) and send it to the doctors.

The symptom diary form can be downloaded to help organize the results of treatment. This is mainly used for people who have already been seen ones and who are undergoing treatment trials.

More information about what to expect at your visit can be found at the Appointment page.