Patient Forms

We want to make sure that your first appointment is enjoyable for you. We’ve provided our patient forms on the website so you can fill them out before you come in.

Please print and fill out all the forms and bring with you to your appointment. Thank You!

Contact our Patient Care Coordinator at 972.439.1331 or info@allenhearing.com.

Patient Intake Form

Financial Policy

Marketing Authorization Form

Authorization to Disclose Health Information

Acknowledgement of Receipt of Notice of Privacy Practices

Prescription List