Hearing 4 Life
Specializing in treating hearing loss
Call: (561) 508-6535

Appointment Request

The first step towards better hearing is to schedule an appointment for a complete hearing evaluation to determine if it is hearing loss or just wax build up. Please contact our office by phone on the number provided above or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.
*Items in bold are required.
Are you a current patient?


Which office location(s) would you prefer for your appointment?


Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.