Forms

Virtual TeleHealth Counselling:

New clients will use a TeleHealth Counselling via an online platform called Doxy.Me.  The link to access will always be:  www.doxy.me/HopeForTinnitus. This will take you to my ‘virtual waiting room’.  If logging on for the first time, please do a pre-call test on the site page in advance of your appointment to ensure that both audio and video are working.  

Ensure that you read the instructions for our virtual counselling below and return a signed Virtual Care Consent Form.

• Instructions for Virtual TeleHealth Counselling
• Virtual Care Consent Form
• Consultations Disclaimer

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize Release of Information

• Authorization to Release Information Form

New Tinnitus Clients please complete the following:

The Tinnitus Assessment Package "TAP" (forms and questionnaires) are located here.  Please ensure that you date/sign and return completed forms to me in advance of our scheduled appointment.

TINNITUS ASSESSMENT PACKAGE:

• Tinnitus Interview
• Tinnitus Handicap Inventory
• Khalfa Hyperacusis Questionnaire
• Dizziness Handicap Inventory
• Tinnitus Cognitions Questionnaire
• PHQ9 - GAD7 Measures
• Stress Symptom Checklist

Thank you in advance for taking the time to complete the documents.

Note: To download Adobe Acrobat Reader for free, click here.