Health Professional Listing Sign Up

ATA's Health Professional Listing helps tinnitus patients across the United States reach out to local health care resources. While the listing is not a formal referral service, and ATA does not endorse or recommend any treatment strategy, they are provided to ATA members who seek suggestions when making important health care choices.

If you are a health care professional with a developed understanding of tinnitus, tinnitus patients and effective tinnitus treatments, please submit the following form to be considered for ATA's listing.

An annual donation of $40* or more ($55* outside the United States) includes ATA's magazine, Tinnitus Today - an informative addition to any office or clinic waiting room. If you have any questions, please contact ATA for additional information.

Please select one:

Title
Email
First Name
Last Name
Address Line 1
Address Line 2
City
State
Zip
Country (if outside U.S.)
Company/Clinic Name
Applicable Degrees
License #
License State
Fax
Website
Telephone

What is your professional specialty? Please check all that apply:

Audiologist	Dentist
ENT/Otolaryngologist	Graduate Level Professional
Hearing Instrument Provider	Medical Doctor
Psychiatrist	Psychologist
Other:

Please check the tinnitus-related Evaluation Services you provide:

Audiological Evaluation	ENT Evaluation
Hearing Instrument Evaluation	Medical Evaluation
Psychiatric Evaluation	Psychological Evaluation
Team Approach	Other:

Please check the tinnitus-related Therapeutic Services you provide:

Acupuncture	Biofeedback / Neurofeedback
Cognitive Behavioral Therapy	Counseling
Electrostimulation	Hearing Aids
Hyperacusis Treatment	Hypnosis
Musculoskeletal Approaches	Masking
Nutritional Approaches	Pharmacological Approaches
Psychiatric Treatment	Sound Therapy
Surgical Approaches	Temporomandibular Joint Disorder (TMJ)
Other:	Pulsatile Tinnitus Treatment

Get involved with ATA and connect with your community by speaking to a local support group:

I am willing to speak to a local support group

Please read carefully before submitting:

By requesting to be included in ATA's Tinnitus Health Professional listing:

- I affirm that I have an interest in helping patients with tinnitus and agree to offer them support and information on treatment options that may provide relief.

- I agree to refer colleagues with an interest in tinnitus to the American Tinnitus Association.

- I agree to stay informed on current tinnitus research through professional journals and Tinnitus Today, and to attend continuing education seminars in the tinnitus field where available.

Applicant understands and agrees by submission of this application, that ATA reserves the right, in its sole and individual discretion, to reject any application or remove any applicant from any Health Professional Listing at any time for any or no reason, notwithstanding that ATA may have previously accepted the same or a similar application and placed applicant's name on a Health Professional Listing.

Pressing "Submit" will process your form and return you to the "About Tinnitus" page.

Thank you for participating and being part of ATA's Health Professional Listing!

*There are two basic ATA membership levels:

• $35 for Online membership
• $40 for Full membership ($55 outside the U.S.)