Intake Forms Please download and fill out the forms or fill out and submit the online registration below. Patient Information Companion Questionnaire Children’s History Form HIPPA Authorization Form Tinnitus Reaction Questionnaire (TRQ) Online Registration Form Your browser does not support iframes. <a href="https://secureform.medpb.com/forms/13207/22825/GlMB/form.html" target="_blank" rel="noopener noreferrer">Click here</a>