Forms for Hearing Testing

Please print and complete the following forms and bring them to your scheduled appointment.

Form 1- Audiology Intake Form for children 0-six months
Form 2- Audiology Intake Form for children six months-five years, not enrolled in our program
Form 3- Request for Release of Information
Form 4- Notice of Privacy Practices Info Sheet (HIPPA)

If you have questions about the above forms, please call the Audiology Evaluation Coordinator at (210) 824-0632.