Patient Intake Form
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What’s Inside the Medical Forms Packet:
- HIPAA Patient Privacy
- Patient Information
- Medical Release
What to expect when you come for your appointment:
- To see a licensed Doctor of Audiology who will test your hearing and diagnose the type of hearing loss, if any, you have.
- To be treated with dignity and respect as a treatment plan for the hearing loss is discussed and agreed upon.
- To be given the necessary time and attention throughout the treatment process to ensure successful outcomes.
When you come for the appointment we would like you to:
- Please bring a family member or close friend to provide a familiar voice.
- Bring the enclosed completed paperwork and active insurance cards.
- Bring a list of all medications and supplements you are currently taking.
- Be prepared to hear better than you have for some time!!!!