Patient Forms

This form captures basic demographic data for patients

new to us.

This form helps collect patient hearing and medical history.

Characteristics of Amplification Tool

This form helps us to better understand your amplification needs.  

This describes our clinic's privacy practices and informs you of your rights regarding your personal health information.  

This form acknowledges receipt of our Notice of Privacy Practices.

This form explains our Appointment and Financial policies.

Get in touch

1161 St. Charles Street, Suite A

Houma, Louisiana  70360

Phone:  (985) 262-7335
Fax: (985) 302-0887

Hours: M-Th 9am-4pm

© 2019 by Comprehensive Hearing Solutions. All Rights Reserved.