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Downloadable Patient Forms

Please access the following forms to assist us with your care.

Print and fill out the appropriate form for the service you require then bring it with you. Or you may scan and email to us. This will help us to better serve you and expedite your appointment.

Patient Information Sheet (Pre-test form)

Please download the Confidential Patient Information form, print it and fill it out before arriving at Affordable Hearing Office in order to speed up your patient registration process.

These forms are required to properly serve your hearing needs. You’ll need this form completed before you can be taken back for testing. It’s easy to fill out, only 1 page.

The Specialized Telecommunications Assistance Program (STAP)

The Specialized Telecommunications Assistance Program (STAP) is a voucher program that provides financial assistance for assistive technology to Texas residents with communication barriers that interfere with access to the telephone. STAP covers the full cost of most assistive phones and devices. This program is available to individuals who are deaf and hard of hearing, as well as those who have loss of vision, mobility, speech, and cognitive function.

Hearing Aid Repair Checklist

Fill this form out if you have trouble with your hearing aids and feel you need our help to resolve the issue. This checklist is designed to help accurately diagnose the hearing aid problem and make absolutely sure your repair is thorough. We want your aid to be fixed correctly the first time.

If you have any questions please call
817-332-6397