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      • Cedar Rapids, IA

        1825 29th St NE, Ste. A
        Cedar Rapids, IA 52402
        (319) 286-8782
        Mon: 8:30am – 5:00pm Tues: 8:30am – 5:00pm Wed: 8:30am – 5:00pm Thurs: 8:30am – 5:00pm Fri: 8:30am – 12:00pm Closed from 12-12:30, Mon-Thurs
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  • Notices

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    • Severe weather closure
      3 years ago
    • Mask mandate in place
      3 years ago
    • Dr. Smith is retiring!
      3 years ago

Patient Forms

January 6, 2022

Printable Forms

New Patient Case HistoryDownload
Hearing Needs AssessmentDownload
HIPAA NoticeDownload
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New Patient Case History

Hearing Needs Assessment

HIPAA Notice

Daily Diary

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  • Cedar Rapids, IA

    1825 29th St NE, Ste. A
    Cedar Rapids, IA 52402
    (319) 286-8782
    Mon: 8:30am – 5:00pm Tues: 8:30am – 5:00pm Wed: 8:30am – 5:00pm Thurs: 8:30am – 5:00pm Fri: 8:30am – 12:00pm Closed from 12-12:30, Mon-Thurs

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