REFERRAL FORM FOR PATIENTS WITH HEARING LOSS AND TINNITUS

We created an online form to make it easier to refer your patients to Cornerstone Audiology for their annual hearing check-up. We recommend annual hearing checks after the age of 50.

Please fill out this form and we will notify your office as well as the patient of their appointment time and date.  

 

If you would rather, please fax patient demographics and insurance information to the following numbers:

Lubbock: 806-687-8965
Big Spring/Snyder: 432-400-3929


Thank you for trusting Cornerstone Audiology with the hearing care of your patients. 
We are happy to partner with you!  

 

Questions? Call our office at 806-687-4327.  

 

Patient Information

Secure HIPAA-Compliant Form