Contact Us: 2945 Bell Road #122 Auburn, CA 95603
Fax: 530-888-1177

Forms

For clients and medical facilities

Audiogram Questionnaire

This is intended to be used by new and existing CHH clients. Please have the forms completed prior to your upcoming scheduled on-site audiometric testing.
Download File

Clinic Audiogram

This is intended to be used by a medical facility. It needs to be fully completed (demographic info, questionnaire and hearing test results) and should be forwarded to Center for Hearing Health.
Download File

Respiratory Questionnaire English Language Participant

This is intended to be used by a CHH client that is scheduled to accomplish a PFT (pulmonary function test) in order to be medically cleared to wear a respirator for work.
Download File

Respiratory Questionnaire Spanish Language Participant

This is intended to be used by a CHH client that is scheduled to accomplish a PFT (pulmonary function test) in order to be medically cleared to wear a respirator for work.
Download File