To better serve you and to maximize your appointment time, please have the following forms completed. You must first PRINT and SIGN the form as signature blocks are not fillable via your keyboard. Please have these forms ready prior to your appointment or you may scan and email to firstname.lastname@example.org
New Patient Intake Form (Page 1) (Fillable Form)
New Patient Intake Form (Page 2) (Fillable Form)
Patient Consent Form (Fillable Form, must PRINT and later SIGN)
Companion Questionnaire (Please PRINT and have your companion complete this form)
If you have Lost or Damaged your Hearing Device, please Contact Us
for immediate assistance.