Patient Forms

WELCOME TO OUR OFFICE

Thank you very much for choosing our office!

If you prefer, you may print the clinic forms from this site and bring them with you to your appointment. This will save you a considerable amount of time on the day of your evaluation.

Please also bring the following items with you:

1. Insurance Card/Cards: The cards will be photo copied to insure all information is
correct to prevent a delay in payment from the insurance carrier.

2. Photo Identification: This will be photo copied and used only for identification purposes or address verification.

3. Physician Referrals (If needed): If your insurance company requires a referral please bring it with you. Otherwise, have your physician e-mail, fax, or mail the type of referral that is required.

4. Previous Tests: If you have been tested previously and have the results of those evaluations, please bring them with you. They will be helpful in assessing your case.

5. Co-Payments: Co-payments are required at the time of your visit. Your co-pay is normally printed on the front of your insurance card.

6. A Familiar voice: During the testing process, we see the greatest benefit when you are accompanied by a friend or loved one. This provides your guest the opportunity to view the testing process while also showing support for you on your journey to better hearing.

7. Arrive Early: Please bring your completed paperwork with you to your appointment and arrive 15 minutes early to allow us to complete your registration process. If your paperwork is not brought in or is not filled out you will need to arrive 30 minutes early or we may need to reschedule your appointment in order to maintain a timely schedule for the courtesy of others.

If you have any additional questions, please call us at (903) 463-9900 or contact us at TheHearingClinic@cableone.net.

Once again, thank you very much for choosing our office!

Patient Intake Form

Patient Responsibility

ABN Form

Questionaire

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