Admission Forms

Listed below are the WTRC Admission Forms required for audiology treatment services at the Center. Click on the specific form you need below and complete prior to your first visit.  You may do this in one of two ways.  You can print it and complete it by hand OR you may type directly into the form and then print. If you are expecting to have a claim with your insurance provider, please bring all necessary documents with you to WTRC. If you need financial assistance with treatment services, please call 325.793.3406 (Abilene) or 325.223.6308 (San Angelo).

 

Adult Hearing History Form

Central Auditory Processing Disorders Case History Form

Dizziness Handicap Index Form

Initial Tinnitus Questionnaire Form

Patient Information Form

Pediatric History Form

VNG History Form

Patient Stories

“I love hearing the sounds that I have missed. Birds chirping, singing in church and being able to understand. My life is good now and it is because of West Texas Rehabilitation Hearing and Balance Center.” - Roberta Dye

Leading Manufacturers

Resound WidexOticonLyric StarkeySiemen SoundCureRextonCochlearPhonak