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PATIENT FORMS

Confidential Patient Information Form
This form requests information about yourself, medical history and hearing history

Pre-Fitting Form Patient Questionnaire, Pre-Fitting Form
This form ask questions about your everyday hearing experiences

Patient Authorization Release Form
This form is optional. We think it is important to keep your Primary Care Physician “in the loop” regarding your hearing health. With your consent, we will provide your hearing evaluation results to your primary care physician.

Testimonial Release Form
This form is optional. The experiences and opinions of people who actually use our products are the best tools for helping others with similar problems.

We accept all major insurance, VA Vouchers, and workers compensation cases.
We also accept all Avesis products for hearing services which include Molina Medicare Advantage - Health 2017 and Care N' Care Hearing 2017. We also accept all donations of used hearing aids!
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