Personalized Hearing Solutions

416.551.4327 (HEAR)
2333 Dundas Street West, Suite 304
Toronto, ON M6R 3A6

Requisition Form


For physicians: please print out or fill in the form online and then print it. Once filled out and printed, please fax it to our office at 1-888-848-2102. We will call you with an appointment time for your patient.

Hearing Aid Central_Requisition Form

For individuals: please print out and have your physician complete the form. Then you have two options:

1) Your physician or their medical staff can book the appointment
2) You can book an appointment at the clinic

Please remember to bring your health card and your completed requisition form to your appointment.

*Please note a requisition form for is not necessary to book a hearing healthcare check or hearing test.

Hearing Aid Central_Requisition Form

If you have a question that is not answered on our site, you can easily contact us or call 416-551-4327.

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