We ask that all new patients and longtime patients who have not been seen in several years complete the below forms. Please bring the completed forms with you to your visit.
In addition to the forms, please bring your driver’s license, insurance card, list of medications and any pertinent records to your visit. Remember, some insurance plans require a prior authorization from your primary care doctor. It is your responsibility to make sure the authorization or referral has been approved. If not, we will try to contact your insurance for an urgent authorization. Your appointment may need to be cancelled or you may be financially responsible for the visit. Dr. John McCaffery is President of Hearing Services of Santa Barbara and contracts with them for Audiologic services.
- Patient Intake Form
- Patient Medical History
- Financial Policy
- Credit Card Policy
- Patient Intake Form (en español)
- Patient Medical History (en español)
- Financial Policy (en español)
- Consent to Receive Text Messages