Patient Forms

Please print and fill out the following forms by clicking on the links provided below and bring them with you to your appointment.

One form is for yourself to complete, and the other form is for your significant other or friend to complete. 

Patient Reviews

Read a Few of Our Google Reviews

4.9 out of 5 Stars based on 100 Reviews on Google.

Read what some of our patients have to say about our staff and our office!

My mother was having trouble hearing and we knew it was time to get it checked. Dr. Jill and her staff are absolutely wonderful to work with. She will assist you with making the right choice of hearing aid based on need and price. Would definitely recommend this practice.

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Nancy Gucciardo, on Google

Locally owned and operated, some say they are however, they certainly are not. Sooooo much experience with state of the art equipment that none in our area have, one piece of equipment only two offices in the state of Iowa have, AND DR JILL IS ONE. She and her staff...

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Delila Happel, on Google

Dr Jill is very professional, passionate and knowledgeable. It will take over an hour for the hearing valuation. Results are outstanding and noticeable. Need to get my actual hearing aids fitted and will have 3 years of updates and recommendations going forward with Dr. Jill's office.

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Edward Dougherty, on Google

On 7.7.22 I had an appointment with Dr. Jill at Hearing Solutions By Dr. Jill. I had gone to Dr. Jill back in 2017 and at that time she evaluated my hearing and was very honest with me telling me that she would be unable to help me until I...

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Stephen Martin, on Google

I was most impressed with the advanced assessment equipment in Dr. Jill’s office. She is most thorough and very informed of her practice. I knew the minute I entered the office, it was going to be a positive experience. The receptionist was very cordial and explained the forms necessary. Dr....

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Sylvia Street, on Google