Client Registration
This new patient form includes general contact information, insurance details and emergency contact numbers. The form grants the Center for Hearing & Speech permission to release any information necessary to process claims related to your care and allows the Center for Hearing & Speech to apply for benefits on your behalf.
Scholarship Application
This form is required for those applying for financial assistance through our scholarship program.
We apologize but the current application window is closed. Please check back on December 1st for the next opportunity.
Red Card Assistance Program
This form is required for those applying for financial assistance through the Red Card Assistance program.
We apologize but the current application window is closed. Please check back on December 1st for the next opportunity.
Privacy Forms
Client Surveys
Case History Forms
Adult Hearing Evaluation (Audiology)
Pediatric Hearing Evaluation (Audiology)
