{"id":11023,"date":"2024-02-20T12:22:52","date_gmt":"2024-02-20T18:22:52","guid":{"rendered":"https:\/\/calliercenter.utdallas.edu\/?page_id=11023"},"modified":"2024-02-21T11:17:09","modified_gmt":"2024-02-21T17:17:09","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/calliercenter.utdallas.edu\/patient-forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"\n

Welcome to Callier Center!<\/h2>\n\n\n\n

We are delighted to serve you for all your hearing health and communication needs.<\/p>\n\n\n\n

New Patient Forms<\/h2>\n\n\n\n

Audiology Adult New Patient Forms (English<\/a>\/Spanish<\/a>)<\/p>\n\n\n\n

Audiology Pediatric New Patient Forms (English<\/a>\/Spanish<\/a>)<\/p>\n\n\n\n

Speech Adult New Patient Forms (English<\/a>)<\/p>\n\n\n\n

Speech Pediatric New Patient Forms (English<\/a>\/Spanish<\/a>)<\/p>\n\n\n\n

Speech Pediatric with Feeding Addendum New Patient Forms (English)<\/a><\/p>\n\n\n\n

Existing Patient Forms (Annual Update)<\/h2>\n\n\n\n

Audiology Adult Annual Update Forms (English<\/a>\/Spanish<\/a>)<\/p>\n\n\n\n

Audiology Pediatric Annual Update Forms (English<\/a>\/Spanish<\/a>)<\/p>\n\n\n\n

Speech Adult Annual Update Forms (English<\/a>)<\/p>\n\n\n\n

Speech Pediatric Annual Update Forms (English<\/a>\/Spanish<\/a>)<\/p>\n\n\n\n

Pre-Test Instructions<\/h2>\n\n\n\n

Be sure to follow all pretest instructions and reach out to Callier Center if you have any questions.<\/p>\n\n\n\n

Auditory Brainstem Response Test (ABR) Information (English<\/a>\/Spanish<\/a>)<\/p>\n\n\n\n

Videonystagmography (VNG) Appointment (English<\/a>\/Spanish<\/a>)<\/p>\n\n\n\n

Adult<\/strong> Comprehensive Assessment of Balance (CAB) (English<\/a>\/Spanish<\/a>)<\/p>\n\n\n\n

Pediatric<\/strong> Comprehensive Assessment of Balance (PCAB) (English<\/a>\/Spanish<\/a>)<\/p>\n\n\n\n

Patient Portal Guide<\/h2>\n\n\n\n

Patient Portal Access and User Guide (English<\/a>\/Spanish<\/a>)<\/p>\n\n\n\n

Patient Portal Proxy Account Request (English<\/a>\/Spanish<\/a>)<\/p>\n\n\n\n

HIPAA Privacy Forms<\/h2>\n\n\n\n

Privacy forms are available under the HIPAA Privacy Manual link on Callier\u2019s website. Scroll to the bottom and click on \u201cHIPAA Privacy Forms Referred to in the Manual<\/a>.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

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