New Patient Forms

New Patient Forms

Please fill in the forms by clicking on the links below. If you have Adobe PDF, you may be able to fill out the forms online. Please print the forms, sign them, and then bring them with you to your appointment.

Patient Form – English

Patient Form – Spanish 

Flexible Financing Available

If you can not afford the full cost of your hearing aids, you may be eligible for financing! Advanced Hearing Group has partnered with CareCredit to bring you flexible financing options you can use toward your next hearing aid purchase.

For more information and to see if you qualify, Click Here.

Referral Form For Your Doctor

Please click the link below to open the form. Print the form and bring to your doctor to fill out.

Patient Referral Form

Happy Patients:

We want to thank Dr. Johnson and the staff at the South Scottsdale office, for their prompt service, when I had a problem, with one of my hearing aids. They saw me within an hour of my call to their office and resolved the problem, in a few minutes. We appreciate a business that is so helpful and caring.

Lisa B.

As a person who was just diagnosed with tinnitus and some hearing loss, I decided to see Dr. Gary Johnson and discuss if hearing aids would be beneficial to me. Dr. Johnson gave me a thorough examination and evaluation and recommended hearing aids for me to help with the hearing loss and help quiet the tinnitus. I have been wearing my new hearing aids for about 2 months now and I am so happy with them. Dr. Johnson did a wonderful job evaluating what would work for me. He is very pleasant, listens to the needs of the patient, answers all questions and makes you feel very comfortable. I have been helped with the hearing aids for both my tinnitus and hearing loss. Don’t hesitate to go see Dr. Johnson if you are in need of someone who can help with your tinnitus and hearing problems. He is the best in the business.

Laura S.

I had a hearing aid quit on me. I went into the Mesa location and was greeted by a pleasant young lady and was promptly helped to get my hearing aid working again. And there was no charge !!Great service and pleasant staff. What a great experience !!

Gordon O.

Set an Appointment

Your Audiology & Hearing Aid Provider in Scottsdale & Mesa

Patient Forms was last modified: November 16th, 2021 by Olivia