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Patient Paperwork

Patient Paperwork

Patient Paperwork may be emailed or mailed to you prior to your appointment, or you can print off your specific packet below (click on PDF). Remember to bring the completed forms with you for a timely check-in process. View our HIPAA Privacy Notice (PDF)

ADULT New Patient Paperwork (PDFincludes:

  • Intake Form
  • Adult Case History
  • Financial Policy
 

CHILD 3 YEARS & YOUNGER New Patient Paperwork (PDF) includes:

  • Intake Form
  • Pediatric Case History
  • EHDI Form
  • Financial Policy
 

CHILD 4 YEARS & OLDER New Patient Paperwork (PDF) includes:

  • Intake Form
  • Pediatric Case History
  • Financial Policy
 

CASE HISTORY FORM Current Adult Patient (PDF)

 

INDUSTRIAL QUESTIONNAIRE (PDF)

 
Timing Your Appointment

Thank you for choosing Constance Brown Hearing Center for your hearing healthcare needs.

During the pandemic, we ask that you come only 5 minutes before your appointment and please limit the number of people coming with you to your appointment. To ensure an efficient visit to Constance Brown Hearing Centers, please allow yourself time to arrive 15 minutes prior to your scheduled appointment.  Appointments are made according to the amount of time the staff anticipates that each patient will need.

Arriving extremely early may cause an extended wait time as other patients will be seen at their scheduled appointment times first.  If you arrive late, we will make every effort to see you but you may be asked to reschedule.

 

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Our Mission

The mission of Constance Brown Hearing Centers is to impact lives through comprehensive hearing care provided by experts with advanced degrees in audiology.

 
Hearing aids have meant everything to me. I can hear much better and enjoy having a conversation with others. A new world has opened up to me because I can hear what others are saying.

— Vivian R. Portage, MI
I chose Constance Brown Hearing Center because of its reputation as an ethical center to have my hearing tested. My recent experience confirmed my expectations.

— Sandra O., South Haven, MI
Our mother is now able to hear birds, conversations, and communicate with friends and family. Your help is appreciated.

—Jerry M. Augusta, MI
Constance Brown Hearing Centers offers convenient locations that are easy to access and handicap accessible. I have no complaints about the service I received!”

— Betsy B. Kalamazoo, MI
I would like to let you know how much hearing aids have changed my life. Since being fitted with a hearing aid, I can hear sounds that I have not heard in years. Thank you so much I am very grateful.”

— Velma K. Paw Paw, MI

 
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