Skip to content
Give Us a Call
Calgary
403-270-7425
Grande Prairie
780-538-2744
High River
403-652-7721
Lethbridge
1-866-402-5552
Calgary
403-270-7425
Grande Prairie
780-538-2744
High River
403-652-7721
Lethbridge
1-866-402-5552
Home
Our Team
Services
Auditory Processing Assessments
Custom Hearing Solutions and Protection
Hearing Tests
Pediatric Hearing Care
Your Visit
Tinnitus
Hyperacusis
Misophonia Treatment
Workplace Hearing
Repair of Hearing Aids
Products
Hearing Aids
Rechargeable Hearing Aids
Starkey Hearing Aids
Behind The Ear (BTE)
Phonak Hearing Aids and Molds
Oticon Hearing Aids
ReSound Hearing Aids
Completely In Canal (CIC)
Invisible in Canal (IIC)
In The Canal (ITC)
In The Ear (ITE)
Receiver in Canal (RIC)
Wireless Media Streaming
FM Systems
Custom Lifestyle Molds
Swim Plugs
Communication Molds
Musician Molds
Pilot Molds
Sleep Molds
Solid Ear Plug
Your Hearing
Causes of Hearing Loss
Hearing Loss Information
Hearing Tests For Children in Calgary and throughout Alberta
Hearing Loss by Profession
Mental Health and Hearing Loss
One-Minute Hearing Check
Risk of Hearing Loss
Anatomy of Hearing Loss
Resources
Blog
Our Videos
How To Videos
How to Change a Hearing Aid Battery
How to Change a Wax Guard for a Custom Hearing Aid
How to Change Phonak Receiver in Canal RIC Wax Guards
How to Change ReSound Receiver in Canal RIC Wax Guards
How to Change Starkey Receiver in Canal RIC Wax Guards
How to Charge ReSound Receiver in Canal RIC Hearing Aids
How to Charge Starkey Receiver in Canal RIC or Behind the Ear BTE Hearing Aid
How to Pair Phonak Hearing Aids to an Android Cellphone
How to Pair ReSound Hearing Aids to an Android Cellphone
How to Pair ReSound Hearing Aids to an iPhone
How to Pair Starkey Hearing Aids to an Android Cellphone
Testimonials
FAQ
Referral Form
Contact Us
Calgary
Social Stories
Lethbridge
Grande Prairie
En Francais
Social Stories
High River
Social Stories
Search
Referral Form
Referral Form
Get Referred For State-of-the-art and Customized Hearing Care Solutions!
Location
Calgary
Grande Prairie
High River
Lethbridge
Date
MM slash DD slash YYYY
Name
*
First
Last
Phone
D.O.B.
MM slash DD slash YYYY
P.H.N.
Untitled
Adult
Pediatric
Audiology is fee-for-service; some services may be covered by 3rd party insurance companies.
Complete Diagnostic Hearing Assessment
Hearing Aids
Industrial / Employment Hearing Screening
Custom Noise Plugs
Auditory Processing Assessment / Therapy
Custom Swim Plugs
Tinnitus & Hyperacusis Assessment / Therapy
Custom Musicians’ Filters
Physician Name
Physician Signature/Stamp/Fax
Max. file size: 128 MB.
Click here
to download the referral form as PDF.
Notes
*
CAPTCHA
Resources
Blog
How To Videos
Our Videos
FAQ
Testimonials
Referral Form
Online Hearing Check
Check it Out!
