Medical Clearance Form

Medical Clearance Form2018-04-22T11:29:21-04:00

Medical Clearance Form

  • PLEASE PRINT THIS OUT AND HAVE YOUR DOCTOR FILL IT OUT-OR-YOU CAN ASK THEM TO FILL IT OUT ONLINE AND SUBMIT IT ON YOUR BEHALF.
 

Verification

Dominick Servedio Audiology:

Dr. Dominick Servedio AuD
Dr. Barbara Grossman AuD
Providing you with the best possible hearing health care in the New York|Manhattan|West Side Audiologist Area

SERVICES:

Diagnosis
Rehabilitation
Prevention of Hearing Loss
Balance Testing and Therapy
Hearing Aids
Audiologial Evaluations
In Ear Monitors
Musician Custom Molds
Listening Devices
Custom Ear Plugs
Hearing Aid Batteries
New Yorks Premier Audiology Office

Content copyright Dr. Dominick Servedio & Dr. Barbara Grossman. All rights reserved 2015 Website designed by inthepresent
Toggle Sliding Bar Area

This Is A Custom Widget

This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.

This Is A Custom Widget

This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.

This Is A Custom Widget

This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.

This Is A Custom Widget

This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.