Healthy Hearing Forms

The Healthy Hearing forms for Pass or No Pass recommendations are available in multiple languages

Healthy Hearing Pass Recommendation Forms

This form indicates sensorineural, conductive, bilateral, and/or unilateral hearing loss; as well as summarizes the services provided by Healthy Athletes and gives recommendations for follow-up services.

Healthy Hearing No Pass Recommendation Forms

This form indicates specific recommendations for follow-up services based on the Healthy Hearing screening.