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For Your Appointment

To schedule an appointment: Call us at 207/874-1065. Please have the following information available:

  • Insurance information. Have your insurance card with you when you speak with us and bring it along with your photo ID to your appointments
  • Primary Care Physician and Referring Specialist information
  • Patient name, date of birth, address, phone number, etc.
  • Reason for appointment (i.e., concerns, etc.)
  • Patient availability for scheduling

For your convenience and to expedite the check-in process, please print and complete the following forms prior to your first appointment at Northeast Hearing & Speech.

(You will need Adobe Acrobat Reader to download and print these forms.
Click here to download)

Audiology Clients:

Adults: (over 18)
Client Data Sheet
HIPAA Summary and/or HIPAA Long Form

Children: (Birth-18)
Client Data Sheet
HIPAA Summary and/or HIPAA Long Form

Speech-Language Clients:

Adults: (over 18)
Client Data Sheet

Case History Form
HIPAA Summary or HIPAA Long Form

Children: (Birth-18)
Client Data Sheet
Case History Form (for children birth-age 5)
Case History Form (for school-aged children)
HIPAA Summary or HIPAA Long Form

We look forward to seeing you at your appointment! Please feel free to contact us today with any questions.

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