DOCTORS

If your patients could benefit from a free, no obligation hearing assessment at ListenUP! Canada, please complete the referral form below – it’s easy!

Enter your patient’s E-mail address and his/her full name below.
Select your recommended service from the drop-down menu.
Enter your full name at the bottom of the referral.
Submit the referral form as an E-mail, or print a copy to to pass along to your patient.

PATIENT REFERRAL FORM


Subject:
Date:
E-mail To:
Dear Full Name:
I recommend you receive the following service by a ListenUP! Canada hearing healthcare professional. Service: ListenUP! Canada has over 100 locations across Ontario. For more information or to schedule your appointment, please call toll-free 310-2244 to reach a ListenUP! Canada hearing aid centre near you. Please print this E-mail and bring it with you to your appointment.

Sincerely Dr.