Patient Forms
Find your appointment type below, click on it and fill out the forms prior to your appointment day.
If you are filling out the form on behalf of a Patient (ex: Parent filling out the form for a Child), please make sure to use the Patient’s name and information to fill out the form, not your own. This will help us find the form once you submit it.
Hearing Assessment
– Children –
Hearing Assessment
– Adults –
Hearing Assessment
– Medical –
Tinnitus Consultation
Cerumen Consultation & Wax Removal
Earmould Consultation
Instructions for your Appointment
(As per COVID-19 Protocols)
- Arrive at the time of your appointment, not before.
- Wear a mask before entering the clinic.
- Use the hand sanitizer immediately when you enter the clinic.
- If your footwear is dirty or wet, use the shoe covers at the entrance to help us keep the clinic clean.
- Come alone at your appointment if possible. If you must come with an accompanying person, please only bring one person with you. (Ex: Only one Parent to come with a Child).
The Patient must also complete the COVID-19 Screening the day prior to their appointment (not before).
If there is an accompanying person, this person must also complete the screening. Please use the form below to do so. There will be a section for the accompanying person if required.
COVID-19 Screening
If you wake up feeling unwell the day of your appointment, please refrain from coming in.
Simply give us a call to let us know and we will reschedule your appointment.
CASLPO Registered Audiologist
Nationally Certified Audiologist
Medical Referrals Are Not Required to Schedule an Appointment.
Contact
373 Vantage Drive, Unit 1, Orléans, ON, K4A 3W2
P 613-841-3033
F 613-319-3611
M 9-6 T 9-6 W 9-5
Th 9-5 F 9-1
