New Patient Forms

//New Patient Forms
New Patient Forms 2018-05-18T09:48:21+00:00

For initial appointments, please complete and bring the patient information form with you to your appointment. Simply click on the form to open and click print. Don’t worry if you can’t download the forms.  Just arrive 15 minutes before your appointment to fill out the information needed for your appointment.

Mid America Audiology Patient Information Sheet

New Patient Hearing Health Assessment

HIPPA Notice

ENG PRETEST INFORMATION

Please click on the form before your test. It is suggested to have someone drive you to your appointment for this test. Please allow at least 1.5 hours for this test to be complete. If you have further questions please call our office.

ENG Pre Test Instructions

REFERRAL REWARD PROGRAM

If you’re happy with the service and products you received from Mid America Audiology Group, please tell your friends or family members and we will recognize you with a referral reward gift card.