5 Locations in
Maryland & Virginia

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5 locations in Maryland & Virginia

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Hearing Assessment Center, LLC
  • Hearing Loss
    • Hearing Loss
    • Hearing Loss Causes
    • Hearing Loss Types
  • Hearing Aids
    • Hearing Aids FAQ
    • Best Hearing Aids
    • Hearing Aid Brands
    • Hearing Aid Online Services
    • Affordable Hearing Aids
    • Over-the-Counter Hearing Aids
  • Services
    • Hearing Testing
    • Hearing Aid Fitting
    • Hearing Aid Repair
    • Tinnitus Treatment
    • Hearing Protection
    • Balance Testing
    • Earwax Management
    • Cognitive Screening
  • About
    • About Us
    • Reviews
    • Patient Intake Forms
    • No Surprises Act
  • Patient Information
    • Literature
    • Video Resources
    • Dr. Cernik on the Radio
    • How To
    • Blog
  • Contact Us
    • Lutherville, MD
    • Bel Air, MD
    • Nottingham, MD
    • Broadmead Retirement Community
    • Warrenton, VA

Patient Intake Forms

New client paperwork forms are available for you to download and print. Please complete all pages and bring them with you to your appointment.

Patient Information Form

Release of Records Form

Hearing Assessment Center, LLC

5 Locations in Maryland & Virginia

Call or Text: 410-816-9723

All Maryland Offices Fax: 410-583-2117

Virginia Office Fax: 540-341-8361

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Medically reviewed by Rory Cernik, Au.D.in February 2021

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