New patients, please complete this audiology case history form and bring it with you during your first appointment. Existing patients, please complete this form if you’ve had any changes.
Please sign and date this form and bring it with you to your first appointment. Existing patients should not need this form.
Wells Fargo Health Advantage
You can enjoy budget flexibility for healthcare expenses by using the Wells Fargo Health Advantage credit card at our office. The Wells Fargo Health Advantage® credit card is issued with approved credit by Wells Fargo Bank, N.A.