Filling out this paperwork at home can save time in the office. Please fill out as much as you can at home if you can.
Make sure to save and print this form as it is not saved online!
A Case History is important for our Hearing Healthcare Team to understand any hearing related issues you have had in the past.
This is a basic form that contains the necessary information to create a patient record with ASI Audiology.
We take Patient Confidentiality very seriously and only release your records with your authorization. This form is required if we are to share your test results with your medical provider or family members.