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Speech - Language and Hearing
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Speech and Hearing

  • Home
  • Meet Our Team
  • Reasons to Make an Appointment
  • Hearing Services
  • Hearing Forms
  • Speech Services
  • Speech Forms
  • Downloadable Brochure
  • What Do Our Patients Say?
  • Contact Us
  1. Patient Care
  2. Welcome to Stony Brook University Hospital’s Speech - Language and Hearing Department
  3. Hearing Forms

Hearing Forms

Auditory Processing Evaluation Forms:

  • APD Letter to the Parents
  • APD Instructions
  • APD History Form - Children
  • APD History Form - Adults


Pediatric Hearing Services Forms:

  • Newborn Outpatient Screening Instructions
  • Pediatric Auditory Brainstem Response Instructions


Balance / Vestibular Disorders

  • Videonystagmography / Electronystagmography (VNG/ENG) Instructions
  • VEMP-ECOG-Adult ABR Instructions



Cochlear Implant Program

  • Pediatric Cochlear Implant History Form — Ages 2 Months - 12 Years
  • Cochlear Implant History Form — Ages 13-18 Years
  • Adult Cochlear Implant Case History
  • Request for release of information
  • Request sent to hearing health professionals
Stony Brook Square Rays
Give us a call
(631) 444-4191
Speech - Language and Hearing
33 Research Way, Ste 4
East Setauket, NY 11733
Hours:
Monday-Friday: 8:30AM-5:00PM
Directions
Hearing Forms 
Speech Forms
Downloadable Brochure
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