{"id":2851,"date":"2018-06-27T10:38:49","date_gmt":"2018-06-27T14:38:49","guid":{"rendered":"https:\/\/www.med.unc.edu\/earandhearing\/?page_id=2851"},"modified":"2021-03-29T10:36:11","modified_gmt":"2021-03-29T14:36:11","slug":"forms","status":"publish","type":"page","link":"https:\/\/www.med.unc.edu\/earandhearing\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"

Financial Assistance for Hearing Aids Application – English\u00a0\u00a0<\/a><\/h2>\n

Financial Assistance for Cochlear Implants Application- English<\/a><\/h2>\n

Application for the Carolina Children’s Communicative Disorders Program (CCCDP). This financial assistance program helps pay for hearing aids, cochlear implant equipment, and other hearing care for children in North Carolina.<\/p>\n

Financial Assistance Application – Spanish<\/a><\/h2>\n

El programa de ayuda financiera del CCCDP proporciona fondos para aud\u00edfonos para ni\u00f1os con p\u00e9rdida auditiva cuyas familias no califican para ning\u00fan otro programa p\u00fablico y que no cuentan con los ingresos para obtener los aud\u00edfonos.<\/p>\n

Financial Assistance Renewal Form<\/a><\/h2>\n

Renewal application for the Carolina Children’s Communicative Disorders Program (CCCDP). Please fill out this form if you are currently enrolled or have been enrolled in the program at any point in the past and wish to renew your child’s status in the program.<\/p>\n

Financial Assistance Renewal Form-Spanish<\/a><\/h2>\n

Para considerar renovar a su hijo para el programa de ayuda econ\u00f3mica, debe completar este formulario en su
\ntotalidad.<\/p>\n

Cochlear Implant Patient Guide – English<\/a><\/h2>\n

Patient guide for families who are new the Children’s Cochlear Implant Center at UNC.<\/p>\n

Cochlear Implant Patient Guide – Spanish<\/a><\/h2>\n

Informacion de Padres y Pacientes<\/p>\n

New Patient Form<\/a><\/h2>\n

This form is for any patient who is new to our clinic. Please fill this out before your first visit with us. If you get stuck, we can help you fill it out during your visit.<\/p>\n

New Patient Form – Spanish<\/a><\/h2>\n

Formulario Para Nuevo Paciente<\/p>\n

Provider List<\/a><\/h2>\n

Please fill this form out whenever there is a change in your child’s hearing care team.<\/p>\n

Medical Records<\/a><\/h2>\n

We are not able to send audiograms or reports directly from our clinic. The parents must request these records directly from medical records. Forms for requesting medical records can be found on the Medical Center website via this link.<\/p>\n","protected":false},"excerpt":{"rendered":"

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Financial Assistance Application – Spanish El programa de ayuda financiera … Read more<\/a><\/p>\n","protected":false},"author":73344,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"layout":"","cellInformation":"","apiCallInformation":"","footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-2851","page","type-page","status-publish","hentry","odd"],"acf":[],"yoast_head":"\nForms | The Children's Cochlear Implant Center at UNC<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.med.unc.edu\/earandhearing\/forms\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Forms | The Children's Cochlear Implant Center at UNC\" \/>\n<meta property=\"og:description\" content=\"Financial Assistance for Hearing Aids Application – English\u00a0\u00a0 Financial Assistance for Cochlear Implants Application- English Application for the Carolina Children’s Communicative Disorders Program (CCCDP). 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