Patient Forms

Save time and complete the necessary forms prior to your appointment!

Please read our HIPAA policy:

• HIPAA Notice of Privacy Practices

NEW PATIENTS:  print, complete and bring with you to your appointment:

• Acknowledgement and Authorization of Notice of Privacy Practices
• Adult History Form
• Pediatric History Form
• Insurance Authorization and Financial

As needed forms:

• STAP Application
• Physicians Orders: Audiology Consultation for Medicare

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