Ear Institute : Tinnitus Clinic

Tinnitus Patient Documents

Please complete and e-mail the following questionnaires to Vickie Smith, tinnitus coordinator, at VSmith2@med.miami.edu, at least 48-hours prior to your scheduled tinnitus evaluation and counseling session. We ask that you please bring a copy of these forms to your scheduled appointment as well.
00178_Tinnitus_History_Questionnaire_Rev.pdf

Tinnitus_Reaction_Questionnaire_00179_Rev_4.pdf

Tinnitus_Handicap_Inventory.pdf

Questionnaire_for_Significant_Other.pdf

Por favor, completa y mande por correo electrónico(e-mail) los siguientes dos cuestionarios a Vickie Smith, coordinador de tinnitus, en VSmith2@med.miami.edu, por lo menos 48 horas antes de su evaluación tinnitus regulares y sesiones de consejería. Le pedimos que por favor traiga una copia de estos formularios a su cita, así.

00178S_Tinnitus_History_Questionnaire__Spanish__rev_1.pdf

00179S_Tinnitus_Reaction_Questionnaire__Spanish__rev_1.pdf

If you have received notice that your insurance provider has denied coverage for the Neuromonics Sound Therapy Treatment program and you would like to appeal this denial, please review the following documents. Please contact your referring audiologist with any questions or comments you may have related to the appeal process.

Patient_Reimbursement_Guide.pdfQuestionnaire_for_Significant_Other.pdf