CUSTOM EAR IMPRESSION FORM

  • Although Maximum care and effort will be taken during the impression process, I understand that the taking of custom ear impression can involve a risk of damage an temporary discomfort to the ear canal. I agree to inform the audiologist of an issue that may arise prior, during and after the impression taking procedure so it can be addressed before i leave the office i acknowledge that all my questions and concerns have been answered to my satisfaction. PLEASE INITIAL THAT YOU HAVE READ THIS.
 

Verification