New Patient Forms at Mt. Harrison Audiology
my harrison audiology logo header

Lifetime Satisfaction Guarantee

mt harrison audiology and hearing aids llc rupert id

Lifetime Satisfaction Guarantee

mt harrison audiology logo

Lifetime Satisfaction Guarantee

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
Privacy of Information
 
receipt of npp
Receipt of
NPP
 
mt harrison audiology patient information form
Email and Text Messaging Consent Form 

For Adults

mt harrison audiology paca form
Areas of Concern Form
 
mt harrison audiology paca form
APD Characteristic Checklist

For Children

children birth to age 3
Children: Birth to Age 3
mt harrison audiology child short form
Children: Age 5 & Up
mt harrison audiology child short form
Children: Age 3-11
ages 12 to 18
Children: Age 12-18
mt harrison audiologist adult fIshers auditory checklist
APD
 
mt harrison audiologist adult fIshers auditory checklist
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.