The Jacksonville Speech and Hearing Center

Patient Forms

Click on one of the buttons below to view and print patient history forms.  Please be sure to complete all paperwork prior to the time of your appointment.


Please note: If paperwork is not completed within the first 15 minutes of your appointment time, the appointment will be rescheduled to allow sufficient time for an evaluation.  Please be sure to bring a valid photo ID and insurance card to each visit.

Click here to view a list of services provided, insurances accepted, and payment options.

 

A portion of every hearing aid purchase is used to help an underserved child with a speech-language problem.