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Get Prepared For Your Hearing Test Appointment

If you haven’t filled out a Case History Form yet, please complete it before your visit.

Instruction: 

  • Please download a form and save it to your desktop.
  • Before you fill out a form, please rename the file name with the following format:
    • “Last Name, First Name – CaseHistory”
  • When you complete filling out all the fields, please hit “Save” again to save all your data.
  • To submit the forms:
    • either hit “Submit” to open your local email application and send out the completed form as an attachment,
    • or just simply attach your completed form to your email and send it to “[email protected]

Case History Form

Download Case History Form

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