New Patient Forms

New Patient Forms

Mt. Harrison Audiology New Patient Forms

We look forward to beginning your healthy hearing journey! Prior to your initial visit, please take a moment to review, print, and fill out the appropriate forms below. Please bring the completed forms with you to your initial consultation. Feel free to call us at 208.312.0957 if you have any questions!

For Everyone

mt harrison audiology patient information form

Patient Information Form

mt harrison audiology marketing authorization

Marketing Authorization Form

Receipt of NPP

For Adults

mt harrison audiology paca form

Areas of Concern Form

For Children

children birth to age 3

Children: Birth to Age 3

mt harrison audiology child short form

Children: Age 3-11

ages 12 to 18

Children: Age 12-18

As one of the premier hearing care centers in Rupert, ID, our team at Mt. Harrison Audiology also provides 5-star-rated hearing services to patients from Burley, Twin Falls, Filer, Malta, Kimberly, Jerome, Heyburn, Paul & Declo, ID, and surrounding areas.