Forms and Documents
All new patients need to complete a Registration Form. All established patients must complete a Registration Form once every year. Completing your forms and sending them to us prior to your appointment helps us to lessen your wait time in the office.
Forms Processing Instructions:
- Click on the link and/or icon and choose to either download or open the form on your computer.
- Print the form using your printer and fill out the forms.
- Bring the completed form(s) into the office at the time of your appointment – OR – fax the forms to Hearing Partners of Texas at (972) 402-9301.
Required Patient Forms
Adult Registration (Use for anyone 18 yrs and older): Please complete all blanks that are applicable in the form. All information is vital to record keeping. Your signature will be obtained when you sign in. Please indicate your primary care doctor or audiologist and the doctor or audiologist or person who referred you. Click to download form Required for new adult patients or if not seen in office in 12 months.
Child Registration (Use for anyone 0-17 yrs old): To be filled out by the parent or legal guardian of the child. Please fill in all blanks that are applicable in the form. All information is vital to record keeping and verification of insurance benefits. Your signature will be obtained when you sign in. The parent or legal guardian must accompany the child to all office visits or a letter of consent naming the person allowed to have the child treated must be sent with the child. click to download form Required for new child patients or if not seen in office in 12 months.
Authorization For Treatment of Minors (Use for anyone 0-17 yrs old): If your child needs medical, dental or hospital services, a parent must give permission. It’s the law. A child may be treated without parental consent when a physician determines a true emergency exists. That means the doctor determines the child needs immediate medical care and that an attempt to obtain parental consent would result in a delay which would increase the risk to the child’s life or health. Except in a true emergency, care may be ordinarily rendered to a child only with the consent of the parent or legal guardian. Sometimes a child may need unexpected care which is not, however, a true emergency. In such cases, making an effort to contact a parent for permission can delay treatment and create unnecessary anxious moments for the child. Fill out this form, give it to the adult(s) you have named to act on your behalf. If your child needs unexpected medical treatment, the responsible adult(s) should present this document to the appropriate person- physician, dentist or hospital representative.