SPEECH AND HEARING CENTER

DEPARTMENT OF COMMUNICATION SCIENCES AND DISORDERS

Note:  Please contact us to have the forms emailed you to you electronically using Hushmail, an encrypted email system (see below).  If you choose to fill out the forms below, you can print them and fill them out by hand.  Some forms are in a fillable pdf format – these forms need to be downloaded to your computer, closed, and then reopened in order to save the information.  Please return any forms by email to scheduling@csdshc.uncg.edu, by fax (336-334-4475), or by mail to:  300 Ferguson Building, UNCG, Greensboro, NC 27402.

Instructions for Using Hushmail

You will receive an email from Hushmail with forms attached.  You will be given a choice to log in to Hushmail using Google, Microsoft, or Apple.  Check your spam if you do not receive the email as expected.  If you have previously logged in to Hushmail using a passphrase, you must continue to use the same passphrase moving forward.

New Client Forms

All clients should complete the following:

Audiology Forms

Patients to be seen for evaluation of hearing or auditory processing should complete the following:

Patients to be seen for tinnitus should complete the following:

Patients to be seen for sound sensitivity (hyperacusis) should complete the following:

Patients to be seen for misophonia should complete the following:

Speech and Language Client Forms

(Complete as appropriate)