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    DESERT SOUNDS Audiology & Hearing Aid Services    6124 E Brown Rd, Ste 102, Mesa, AZ        480-497-3285

    ...life never sounded so good.                                                                              Call today to start hearing better!

    Last edited:  01/02/2008 

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[Under Construction]
Satisfaction Insurances Forms Staff HIPAA

Forms, no one likes to fill out forms.  Unfortunately, we need to have you fill out forms for contact and billing purposes, HIPPA for patient confidentiality, and our patient consultation form.  If you are coming because you are dizzy or have balance problems, we have an additional form for you to fill out.

Things you want to bring to your appointment:

  • Insurance Cards
  • Identification, especially if you are referred by DES (Department of Economic Security)
  • List of Medications
  • Hearing Aids if you have any
  • Glasses, so you can see and read

Intake Forms (everyone fill this out)

PATIENT DEMOGRAPHICS Word Document   or PDF
HIPAA Word Document  or PDF
CASE HISTORY FOR HEARING TEST Word Document  or PDF
BABY & TODDLER HISTORY FORM Word Document  or  PDF
DIZZY TESTING Word Document 
DIZZINESS HANDICAP INVENTORY Word Document
RECORDS RELEASE FROM DESERT SOUNDS TO: Word Document
RECORDS RELEASE TO DESERT SOUNDS FROM: Word Document

Dizziness and Balance Questionnaire and Special Instructions

 

 

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Copyright © 2006 DESERT SOUNDS Audiology & Hearing Aid Service, LLC
Last modified: 01/02/08