Optimal Hearing, Unbeatable Service

816.373.7900

3. HIPAA Authorization to Use and Disclose Information

1. New Patient Registration

4. HIPAA Marketing Short Form

2. Patient History

These forms are required for all new patients and annually for current patients.  You may save them to your computer, print them, complete as required and return to our office at your first (or next) visit.  Alternatively, please come to your appointment 15-30 minutes early to complete these forms.  Thank you.

Forms