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
Patient Information Form
Marketing Authorization Form
Privacy of Information
Receipt of
NPP
NPP
Email and Text Messaging Consent Form
For Adults
Areas of Concern Form
APD Characteristic Checklist
For Children
Children: Birth to Age 3
Children: Age 5 & Up
Children: Age 3-11
Children: Age 12-18
APD
APD Characteristic Checklist
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.