Tinnitus Appointment Checklist: A Template and Worked Example

Start with when you first noticed the sound, which side it seems to be on, how it sounds, and how it affects daily life. Add a few dated observations if you already have them. You do not need weeks of tracking before you can ask for care.

Open the free appointment worksheet to copy, download, or print a blank version. This is an organization aid, not a diagnostic checklist or a validated questionnaire.

What to bring

• Timing: first noticed date, whether the start was sudden or gradual, and whether the sound is continuous or comes and goes. “Not sure” is useful information.
• Sound and side: your own description, such as ringing or hissing; left, right, both, or unclear. Note whether it seems to pulse with your heartbeat.
• Loudness and bother separately: optional personal 0–10 ratings. Keep your own anchors consistent; these are not a hearing test or a clinical score.
• Daily impact: one concrete example about sleep, concentration, work, or mood, rather than a score alone.
• Context and questions: relevant hearing changes, noise exposure, medication list, existing test results, and what you want to ask. Record observations without deciding that one caused another.

A filled example

Fictional example — not patient data, an app export, or a medical interpretation.

Appointment summary — October 8–10, 2026
First noticed: early September; exact date not recorded
Description: steady high ringing, seems louder on the left
Heartbeat-like pulse: not noticed
October 8: loudness 4/10, bother 6/10; interrupted reading
October 9: loudness 4/10, bother 3/10; completed usual work
October 10: no entry
Hearing changes: not recorded — ask about a hearing assessment
Other context: short sleep on October 8; cause unknown
Main question: what assessment and follow-up would be appropriate?

A missing entry stays missing. The different bother ratings do not prove that sleep, work, or a particular treatment changed the tinnitus.

Questions you could ask

1. What should be assessed given my history and the way I describe the sound?
2. Would a hearing assessment be useful?
3. Which changes should make me seek earlier care?
4. What support is available for the parts of daily life most affected?
5. Is a brief record useful for follow-up, and what should I include?

The NIDCD explains that evaluation can include a history, examination, and referral to an ENT or audiologist. A worksheet helps organize what you tell them; it cannot choose the evaluation.

When the diary can wait

Sudden hearing loss is a medical emergency. Seek immediate care instead of waiting for an appointment or a complete diary. Tinnitus with new facial weakness or spinning dizziness, or after a head injury, also needs emergency care. Heartbeat-like pulsing needs prompt clinical advice. Persistent, worsening, one-sided, or bothersome tinnitus warrants assessment. Use your local urgent or emergency services as appropriate; this page cannot triage you.

Where OtoNote fits

The iPhone app is designed to keep intensity, bother, side, sound, and context together. Free app features include daily records and a 7-day view; PDF/CSV exports and longer views belong to Pro. The website worksheet is free independently of Pro or App Store availability. It is not the app's PDF export.