Forms

 

Patient Forms for Your NWA Hearing Resources

 Located in Bentonville, Arkansas

For convenience, you can download patient forms (PDF format) to fill out in advance of your first visit. Bring the completed forms with you or send them to our Bentonville office (479) 657-6464 

  • Patient Intake Form (All Patients)
  • Pediatric Case History Form
  • Adult Case History Form
  • Personal Release of Information (All Patients)

 

Vestibular Evaluation

 

 

(Bring the forms with you or send them to (479) 657-6464, or email audiology@betterhearingandbalance.net)


Specialized Telecommunications Assistance Program application for telephones needed by those with hearing loss and other disabilities.

 

 

We never share patient information. Download a copy of our Privacy Policies.

 

 

Your Goals Are Our Goals


We promise to work closely with you to discover where you are having the most difficulty communicating. Then, we will collaborate with you to determine the best solution to increase your ability to hear and understand in the situations you describe. If that solution includes hearing aids, then we are committed to recommending the technology that:


  • Works best for your level of hearing loss;
  • Complements your lifestyle and...
  • Fits within your budget. Your satisfaction is our ultimate goal.
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