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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

Speech to Text Equipment Request

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