Proudly Celebrating 65 Years
Chattanooga Skyline

Patient Form

Patient Form

To expedite the check-in process, please print the appropriate intake forms and mail or fax to the location below prior to your appointment. If you cannot send forms prior to your, please bring completed forms with you.

The Speech & Hearing Center
Attn: Front Office Specialist
2212 Encompass Drive, Suite 1500
Chattanooga, TN 37421
Fax: 423.622.4843

Intake Forms – Speech Pathology Patients

Speech Intake Forms for Adults
Speech Case History Child Form

Intake Forms – Audiology  Patients

Hearing Case History Adult Form
Hearing Intake Forms for Children