Skip to main content

Forms

Please read all of the options to select the most appropriate form, then complete all fields including signatures and send to info@auditoryoutreach.ca or fax to 1-604-485-2759.  

We appreciate inclusion of the most recent audiology report or audiogram with all requests. Any requests for new students or students who have moved to a new school district also require a signed Permission to Share Form. Incomplete requests will result in delays. 

For questions about requests and which form to use, please contact Lora Baker at info@auditoryoutreach.ca or (604) 414-2637.

Equipment Request

Permission to Share

CI Equipment Request 

CI Equipment Exchange

CI Request for Outreach Support

Accessory Request

Equipment Exchange

Equipment Loss

Equipment Return

Technical Service Request

Back to top