Recommendations for Testing Patients: Cochlear Implant Center: University of Iowa Health Care

Cochlear Implant Center Home

Contact Us

About Us
Dot History
Dot Why Us?
Dot Staff and Faculty
Dot Nursing Staff
Dot Annual Newsletter

Health Topics
Dot Cochlear Meningitis Vaccination
Dot What is a Cochlear Implant?
Dot Glossary

Patients
Dot Patient and Visitor Information
Dot Hospital Directions

Websurveys for Patients
Dot Benefits of Receiving a Cochlear Implant: Study for Adults
Dot Cochlear Implants and Tinnitus Survey

Providers
Dot Referring Physician Resources

Recommendations for Testing Patients
Dot Recommendations for Testing Adult Bilateral Cochlear Implant Patients
Dot Spatial Hearing Questionnaire

Research

UI Department of Otolaryngology—Head and Neck Surgery

Patient Background Form

1. Birthdate: (Format: YYYY)

_______________

2. At what age (in years) did you become profoundly deaf?

Right ear: _______ Left ear: _______

3. When did you receive your (Format: YYYY/MM):

Right Implant: ________ Left Implant: ________

Last modification date: Mon Apr 28 09:02:17 2008
URL: http://www.uihealthcare.com /depts/med/otolaryngology/clinics/cochlearimplant/testingspatients/backgrounddata.html