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