Clarksville Center for Audiology
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Patient Information


Clarksville Center for Audiology - Patient Information

New Patient Information

For initial appointments, simply click on the Patient Intake Forms link below to open and print the necessary forms. Complete and bring the forms with you to your appointment. Included in the Intake Forms Section is our Notice of Privacy Practices.

For a release of Medical Records, simply click the link below to open and print.

 
 

Insurance Information

We are participants with Medicare and most health insurance plans. Although Medicare does not provide benefits for hearing health devices or routine hearing testing, our office will still file Medicare and any supplement insurance(s) for payment. Our staff will ensure that you receive any benefits included in your plan(s). We will gladly file all insurances regardless of contractual participation.

 

Payment Methods

We accept the following forms of payment. Cash, Check, Cashier’s Check, Money Order, Visa, Master Card, American Express, Discover, and the Wells Fargo Health Advantage® credit card*

 

*The Wells Fargo Health Advantage® credit card is issued with approved credit by Wells Fargo Bank, N.A.. See your provider for details.

To apply online, click this link https://retailservices.wellsfargo.com/pl/2169094026