Connect with us for a hearing evaluation (480) 833-4330

New Patient Forms

What to bring to your first appointment:

  • Photo ID
  • Insurance card(s)
  • List of current medications
  • New patient intake form  (located below: print and complete)
  • HIPAA agreement form (located below: print, sign, and date)

For your convenience, our new patient forms are below in PDF format. Click to open and print. Please complete prior to your first appointment.

Also included below is our Notice of Privacy Practices Agreement form. Click to open and please read, sign and date this consent form prior to your appointment. Thank you.

New Patient Intake Form – Adult (Fillable PDF)

New Patient Intake Form – Adult

New Patient Intake Form – Child

Notice of Privacy Practices Agreement form