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.