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Hearing Screening Follow-up Form
© Aphasia Institute 2015
AI Hearing Screening Follow-Up Form 1
Hearing is important!
Beep!Hello!
Thank you for having your hearing screened!
© Aphasia Institute 2015
AI Hearing Screening Follow-Up Form 2
Hearing screening results
You heard all the beeps.
We think you could have a hearing problem.
Beep.
Beep.
© Aphasia Institute 2015
AI Hearing Screening Follow-Up Form 3
Share results with your doctor
Ask about an appointment to see an audiologist
Doctor
Beep.
Beep.
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