We have issued an important message regarding our policies and precautions concerning COVID-19. Please take a moment to read it here.
1161 Saint Charles St. Suite A Houma, LA 70360
Mon - Thu 9 am - 4 am 985-262-7335
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Patient Intake Form
This form captures basic demographic data for patients
new to us.
Patient History
This form helps collect patient hearing and medical history.
Characteristics of Amplification Tool
This form helps us to better understand your amplification needs.
Notice of Privacy Practices
This describes our clinic's privacy practices and informs you of your rights regarding your personal health information.
Notice of Privacy Practices Receipt
This form acknowledges receipt of our Notice of Privacy Practices.
Appointment
& Financial Policies
This form explains our Appointment and Financial policies.