All patients must fill out the the registration and
history forms. Please click below
to download the 2 forms.
Patients coming in for the first time for dizziness, need
to fill out the three forms below:
Patients consulting regarding ringing in the ears
(tinnitus), need to fill out the two forms below:
All new patients for Dr. Djalilian:
To make your visit smoother to the ear and skull base
clinic, please bring all previous hearing and balance
tests with you. Also, please bring copies of any ear or
brain imaging studies (CT or MRI) with you. Please bring
the films or the CD of the images - the written report
is not sufficient.