Registration Forms

Please print and complete:

1) Either an Adult OR Pediatric Registration Form

2) A Consent/Release Form

  • Please bring these forms with you for your scheduled appointment.

  • To schedule an appointment, please call our Newark or Coshocton offices.

Main Office:

36 McMillen Drive,

Newark, OH  43055

Phone: 740-344-1304

Fax: 740-344-1305

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For Life-Threatening Emergencies Call 911

© 2020 Clear Choice Audiology LLC.