You have successfully submitted your service request form.
NEXT STEP: Click this button to download Records Review Packet and Checklist
The next step is to download the Records Review Packet by clicking the orange button on this page. In the questionnaire you will find an important checklist to complete before we can give you an estimate for cost of service or setup your conference with the physician.
If you have any questions in filling out the questionnaire, our office phone is (813) 315-HEAR, ask to speak with a “Records Review Specialist.” You may also email us at firstname.lastname@example.org
Note to users of Windows 8, Internet Explorer 10, and Internet Explorer 11
There is a known issue downloading PDFs using the above versions of software that triggers a pop up that appears similar to the displayed picture.
Click “OKAY” to the pop up message to continue to download the PDF Form that is needed for your appointment. You may read more about this issue from Adobe Technical Support website at the following addresses: