Tinnitus Treatment
Tinnitus and Hyperacusis
Hyperacusis and Misophonia
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NOTE: For those suffering from tinnitus, once you have completed this form
please click on the Tinnitus Handicap Inventory link and complete the form
.
Name
(required)
Phone Number
(required)
e-mail
(required)
Primary Complain
Please click and select
Hearing Loss
Dizziness
Tinnitus (Ear Ringing or other)
Hyperacusis (Loudness Sensitivity)
Other
Type/Name of Insurance (If Any)
Comment
(required)
