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Patient Forms

scopeRequest an Appointment
By clicking on the link above you can request an appoinment and submit it electronically to our office.

Patient Information & Medical History Form
By clicking on the link above you can fill out our patient registration form and submit it electronically to our office.

Make a Payment
By clicking on the link above you can make an
online payment and submit it electronically to
our office.

Health Information Online
By clicking on the link above you can access
your health information online, using the
Patient Portal. For more information Click Here

Videonystagmography (VNG) – Instructions
By clicking on the link above you can access
the Videonystagmography (VNG) Instructions.
Please read the instructions at least 3 days
prior to your appointment.

Before And After Surgery Information
By clicking on the link above you can access
instructions for your upcoming surgery.





Providers
Jacques Herzog, M.D.
Carolyn Bequette, MS, CCC-A
Susan Rathgeb, MS, CCC/A

Office Policies
Disclaimer
Financial and Insurance
Cancellation Policy

For Our Patients
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Before And After Surgery Information
Local Hotels
Link to pay online
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by MedClick 24-7


Services
Medical Services
Pediatric Otology
Surgical Services
Vestibular Services
Cochlear Implants
Cochlear Implants In Infants

Audiology Services
Hearing Aid Services
Cochlear Implant Services
Other Services
Communication Strategies
Audiology Store
Helpful Links

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Patient Education
Acoustic Neuromas
BAHA Implants
Benign Paroxysmal Positional Vertigo(BPPV)
Cochlear Implants
Cochlear Implants in Infants
Cholesteatoma
Chronic Ear Infections
Dizziness
Eustachian Tube Problems
Facial Paralysis
Fully Implantable Hearing Aids
How We Hear
Meniere's Disease
Sudden Hearing Loss
Superior Semicircular Canal Dehiscence Syndrome
Surgical Management of Hearing Loss
Tinnitus
Vestibular Neuronitis
Vestibular Rehabilitation
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