Advanced Audiology Associates | New Patient Info Form

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Yarmouth Port: 508-385-5222

Marstons Mills: 508-539-9780

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Patient Information Form, HIPAA and Insurance Payment Consent

I authorize Advanced Audiology Associates, Inc. to release information requested with regard to processing my claims. I understand and agree that (regardless of my insurance status), I am ultimately responsible for the balance on my account for any professional services rendered. I have read all the information on this sheet, and certify that this information is correct to the best of my knowledge

I accept full responsibility for all charges in the event that I have no insurance or third party benefits. Charges 30 days past due are subject to late fees.

Yarmouth Port Office

714 Main Street (Rt. 6A)

Yarmouth Port, MA 02675

508-385-5222

Marstons Mills Office

86 Cotuit Rd. (Rt 149), Unit B1

Marstons Mills, MA

508-539-9780

Advanced Audiology Associates, Inc. is a full-service hearing care practice. We can provide physician-ordered diagnostic hearing testing, hearing aid evaluations and consultations, advanced hearing aid technology, hearing aid accessories, batteries, and assistive listening devices.

© 2024 Advanced Audiology Associates, Inc.

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