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Thank you for your interest!
We are happy to try to help you with your ear problems.
We usually call our patients back M-F between 7-8pm Mountain Time.
Name
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Email
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Cell Phone
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Do you have a computer at home for a tele-visit? (Select One)
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Yes
No
Name of the doctor who sent you?
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Name of insurance carrier?
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Did you have a hearing test already? (Select One)
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Yes
No
Do you have your hearing test in your hands? (Select One)
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Yes, I have it physically in my hands
No, I do not yet have it in my hands
Have you had any type of scan?
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