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In case of inclement weather, we follow the Grapevine Colleyville School closing schedule.
Audigy Certified Practice

Grapevine

2260 Pool Rd, Ste 300
Grapevine, TX 76051

(817) 803-4646

(817) 488-2854

Heard It Through the Grapevine Audiology
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Patient Paperwork

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Printable Registration Forms

Save time by printing the necessary forms below and bringing them with you to your appointment. Also, please bring a current copy of your driver’s license or state ID and a copy of your current insurance or Medicare card to every appointment.

New Patients

  • Adult Case History
  • Pediatric Case History
  • Newborn Case History
  • Demographic Intake Form
  • Patient Communication Authorization of Disclosure
  • Tinnitus Index
  • Information and Technology Update
  • Consent and Financial Policy
  • Privacy Practices
  • Companion Questionnaire
  • Characteristics of Amplification Tool (COAT)
  • Children’s Home Inventory for Listening Difficulties (C.H.I.L.D)

Returning Patients

  • Annual Case History
  • Demographic Intake Form
  • Consent and Financial Policy
  • Patient Communication Authorization of Disclosure
  • Privacy Practices
  • Information and Technology Update

Contact Us

Grapevine

2260 Pool Rd, Ste 300
Grapevine, TX 76051

(817) 803-4646

(817) 488-2854

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Patient Testimonial

Audigy Certified Practice

Heard it Through the Grapevine Audiology is recognized as an AudigyCertified™ practice. AudigyCertified™ expertise is measured by commitment to patient satisfaction, continuing education, and the expert application of current technology.

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