Fine Hearing Care
2801 South Bryant
Edmond, OK 73013
405-340-9191

Patient Forms

We have provided the patient health/information forms needed before receiving treatment from Fine Hearing Care. We encourage you to print out the age appropriate forms you need; enter the information and bring the completed forms with you for your appointment. If you have any questions do not hesitate to call the office. We will be glad to help.

You will notice that there are multiple forms for each age level. Print out and complete all the appropriate forms needed for your family member.

 

Infants (up to 12 months)

• Infant Information
• Infant History
• Notice of Privacy Practices Acknowledgement

Children (1 to 12 years)

• Pediatric Information
• Pediatric History Form
• Notice of Privacy Practices Acknowledgement

Adults

• Patient Information
• Patient History Information
• Notice of Privacy Practices Acknowledgement