Download our Patient Forms
Please download and print the forms below. Complete and sign where indicated on each form. Bring all forms to your appointment 10 minutes prior to your scheduled time. The Notice of Privacy Practices is for your information only and does not need to be brought into the office.
Please let us know if you have any questions. Thank you for choosing Wake Audiology as your hearing care provider.
- New Patient Information
- Adult Case History
- Child Case History (For patients up to age 16)
- Authorization to Use and Disclosure of Health Information
- Financial Policy
- Communication Profile
- Advance Beneficiary Notice of Noncoverage (For patients with Medicare as their primary Insurance, not for Medicare Advantage plan holders)
- Notice of Privacy Practices (For patient's information. Does not need to be brought to the appointment.)