The form below and the forms to be completed in the left sidebar are all HIPAA compliant. For your convenience and safety we will have you complete these forms prior to your (first) visit. (But do not worry if you forget – you can always complete them at the office as well). Your information will remain completely private and protected and only be viewed by your physician and appropriate and credentialed staff at Acoustic Hearing Center.
Directions: Print & complete the attached forms for your visits and/or treatment. Complete all applicable fields and bring with you to your appointment.
*We accept most
Federal & State insurance plans.