Audiological Reports & Referral form for Physicians and Other Healthcare Providers

Doctor of Audiology–Led Assessment & Reporting

Ottawa Hears Audiology provides detailed audiological assessments and written reports to support physicians, nurse practitioners, ENT specialists, neurologists, SLP and other healthcare providers in patient care and referral planning.

Our reports are prepared by Genia Kanne-Shmigol, Au.D.(C), Doctor of Audiology, Audiologist, a clinical and dispensing audiologist in Ottawa with over 14 years of experience. Reports are based on advanced audiological knowledge, specialized testing, comprehensive assessment, and clinical interpretation.

How to Refer

Download Physician Referral Form

Please download and complete the referral form, then fax it to:

Fax: (613) 707-3459

To help us triage the referral efficiently, please include the reason for referral, relevant medical history, patient contact information, and any previous audiograms or related reports if available.

Once received, our team will contact the patient to arrange the appropriate audiological appointment.

When to Refer

Physicians may refer patients for audiological assessment when there are concerns such as:

✅ Sudden or unexplained hearing changes
✅ Asymmetrical hearing loss
✅ Presbycusis / age-related hearing loss
✅ Tinnitus, especially unilateral, pulsatile, or bothersome tinnitus
✅ Ear fullness, pressure, or suspected middle ear involvement
✅ Dizziness, imbalance, or vestibular-related concerns
✅ Hearing changes following illness, infection, noise exposure, or injury
✅ Abnormal otoscopy or middle ear findings
✅ Difficulty understanding speech despite “normal” basic hearing results
✅ Need for audiogram, report, funding forms, or specialist documentation

Please note: Our reports provide advanced audiological findings, clinical interpretation, and recommendations for next steps when warranted. While audiologists do not diagnose medical conditions, our assessments may identify audiological patterns or red flags that support timely medical follow-up, specialist referral, or further investigation by the appropriate medical provider.

Audiological Report & Medical Recommendations

When clinically warranted, our audiologist may provide a detailed audiological report for your physician, including findings and recommendations for next steps. This may include a recommendation to follow up with an Ear, Nose and Throat physician, neurologist, or another healthcare specialists. If the audiological findings suggest that further medical investigation may be needed, we may recommend that you discuss diagnostic imaging, such as MRI, CT scan, ultrasound, or other testing, with your physician.