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Hearing Screenings at the RiteCare Center for Communication Disorders
This form will allow our therapists to best serve your individual needs. The screening should take no more than 20 minutes
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Phone number
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Name
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Age
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What days work best for your schedule?
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Monday
Tuesday
Wednesday
Thursday
Friday
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What times work best for your schedule?
7:00 AM
8:00 AM
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10:00 AM
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4:00 PM
5:00 PM
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