Initial Tinnitus Assessment Form

Tinnitus Aspects

How long have you had tinnitus?

Can you recall where you were or what you were doing when you first became aware?

What do you consider to be the cause of your tinnitus?

Please describe the onset of your tinnitus.

Please describe the sound of your tinnitus.

Please describe the location of your tinnitus.

Please describe the frequency of your tinnitus.

What tinnitus treatment have you tried?