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Tucson AZ 85741 520. 742. 2845 fax 520. 742. 3881 Tucson-Ventana/Foothills 6969 E. Sunrise Dr. 200 www. Companion Questionnaire Name Patient Name Relation to Patient Date In our professional experience we have found many of our patients describe hearing loss as the misperception of sounds that affect not only their normal daily routines but the lives of those around them. We would like to ask you a few situational questions to better understand your companion s listening lifestyle and how we...
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