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Requesting Clinic Services


Clinic paperwork can be downloaded from this page or are available from our clinic office.

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  • Requesting Clinic Services
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    Referrals may be made by self, parent, physician, educator,psychologist or any other related professional or agency. We are a health care provider for many third-party insurance companies. For insurance coverage doctor's orders are frequently requested. We are not a Medicare provider. Contact the clinic to inquire about specific insurance and payment needs.

    Please Note: The Hearing and Speech Clinic will accept completed paperwork via fax, mail, or hand carried to the clinic.

    Hearing Services:

    For hearing loss related services please use the age-appropriate case history form:

    Adult Audiology

    Child Audiology

    Speech and Language Services: 

    For Speech and language services please use the age-appropriate case history form:

    Adult Speech-Language

    Child Speech-Language


    Summary of Patient Privacy (HIPAA)

    Contact Information

    University Hearing and Speech Clinic
    310 North Riverpoint Blvd Box V,Spokane, WA 99202
    Spokane, WA 99202

    phone: 509.828.1323
    fax: 509.368.6890

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