For your convenience, below are the required forms you will need to complete before your next visit with Elk Grove Hearing Care. To save time, you may print them out at home and complete them before you arrive.
Pediatric Intake Form: This form contains information about your child and their hearing loss history.
Notice of Privacy Practices: This form contains information about how your medical information will be used and how you can gain access to this information.
HIPAA Authorization to Disclose Protected Health Information: This form gives your physician permission to share your health information with Elk Grove Hearing Care.
HIPAA Authorization for Release of Protected Health Information: This form gives us permission to share your health information with your physician.