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#620, 4445 Calgary Trail NW Edmonton, AB T6H 5R7 pH: 7809441609 TF: 18005370589 FX: 7804083925 registration@acslpa.ca www.acslpa.caREQUEST FOR VERIFICATION OF ACIPA REGISTRATION General Verification
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Fill out the necessary personal information such as name, address, and contact information.
02
Provide details on your medical history and any existing conditions or treatments related to your hearing.
03
Include information on your current audiologist, if applicable, and any previous hearing tests or evaluations.
04
List any concerns or specific areas of focus you would like the audiologist to address during your appointment.

Who needs is your audiologist or?

01
Anyone experiencing hearing difficulties or concerns about their hearing health.
02
Individuals who have noticed changes in their hearing and want to get evaluated by a professional.
03
People who have been recommended by their primary care physician or other healthcare provider to see an audiologist for further assessment.
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The audiologist evaluation assesses the patient's hearing health and provides a diagnosis.
Audiologists, hearing healthcare professionals, and medical professionals may be required to file the audiologist report.
The audiologist report can be filled out by providing detailed information about the patient's hearing test results, medical history, and treatment plan.
The purpose of the audiologist report is to assess the patient's hearing health, diagnose any hearing issues, and create a treatment plan to improve their hearing.
Information such as the patient's hearing test results, medical history, current medications, and treatment plan must be reported on the audiologist report.
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