Grusecki Audiology

12691 W. Smokey Drive Suite #131, Surprise, AZ 85378
Phone: (623) 583-1737
Fax: (623) 583-0607
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Patient Forms

Patient Intake Form

Please read Grusecki Audiology & Hearing Aid Services, LLC’s HIPPA privacy policy and then print and sign the following 2 forms (required by federal law):