Book Appointment – Patient ReferralAudiology: Patient Referral Telethon Speech & Hearing (TSH) Audiology specialises in testing the hearing of newborns, infants, toddlers, children and adults. If you are a referring health specialist, please complete the online request form below on behalf of a patient, client or student: Name* First name Surname Email* Phone number*Date of birth* Date Format: DD slash MM slash YYYY GenderMaleFemaleHistory / Complaint*Appointment required Full hearing assessment - Adult Full hearing assessment - Child Infant diagnositc assessment 0-6 months (electrophysiological testing) Hearing aid evaluation Cochlear implant assessment Cochlear implant mapping Work cover assessment - Baseline Work cover assessment - Full audiological Pre-employment assessment Swim plugs Noise protection / musician's ear plugsREFERRING SPECIALIST DETAILS* First name Surname Provider number (if applicable)Book Appointment – Patient ReferralHearing Loss in ChildrenHearing Services for Newborn BabyHearing Services for Pre-School ChildrenHearing Services for School-Aged ChildrenEarly Intervention Hearing Impaired Program (Chatterbox)
