PATIENT FORMS

View our form online.

You can help ensure that your appointment goes quickly and smoothly by having our patient intake paperwork completed before your appointment. You can fill them out on your computer and email them to info@hearingcarecarsoncity.com before your appointment.

You can simply print them, fill out the necessary information and bring them with you to your appointment.

 

Download Form

Click the button below to download and print our patient intake forms.
If you have questions about any aspect of our service, please let us know by calling our office at (775) 297-4131.

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Single

ONE MONTHLY CHECKUP

$150/year
Affordable
Preventive Care
Diagnostic Tests
Skilled Nursing Care
Request Plan

Family

FOUR MONTHLY CHECKUPS

$250/year
Emergency Care
Diagnostic Tests
Prescription Drugs
Habilitation services
Request Plan

Premium

UNLIMITED CHECKUPS

$350/year
Practitioner Visits
Imaging (PET/MRI)
Specialist Visits
Specialty Drugs
Request Plan

Have a question about our patient form?