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Hearing aids and audiology

Appointment Request
Patient Information Form
Medical History

Register Online

Below are the forms that you will need to fill out at your appointment. Completing these forms now will allow you to register more quickly when you arrive for your appointment.

Step 1:

Fill out an Appointment Request Form.
(if you haven't already scheduled your appointment)

Step 2:

Complete your Patient Information Form.

Step 3:

Complete your Medical History Form.


Privacy and Financial Policies

Before your appointment, please also review our policies regarding privacy and payment below. You will need to sign acknowledgement of these policies at your appointment.

3099 River Road South, Salem, Oregon 97302-9754. Phone: (503) 581-1567.

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