Complete Your Patient Forms Online

To make your next visit as simple as possible, all your paperwork has been digitalized.

By selecting the form required below you will be able to complete your answers quickly and easily online.

If you need any further guidance, have any questions or need our help filling out any of the forms, please call our friendly team at (325) 437-4730 who will be happy to help you. 

Patient Intake Form
Hearing History Form
Consent For Treatment
Re-Evaluation Form
Advance Beneficiary Notice of Noncoverage (ABN)
Tinnitus Handicap Inventory
Release Records Form

Request a Callback

It’s often the small things that hold us back from making a decision, now is the time to discuss those “things” with one of our audiologists.

We’re here to help.

Simply complete this form and one of our audiologists will reach out to you to answer any questions you might have.

My experience with Holland Hearing from day one was wonderful!How Bill Was ‘Floored’ By The Difference
I first realized that I had a hearing loss 30 years ago when I started to hear a bothersome noise in my ears. I first thought this was tinnitus. The first person that I went to said I had a little high frequency loss and there was nothing that could be done about my tinnitus. Then I started having difficulty accurately hearing certain words, especially in crowds or at a restaurant. As time passed and I knew I needed to get my hearing tested again, my biggest fear was that the tinnitus could not be mitigated and that any devices I needed were financially out of my reach. My experience with Holland Hearing from day one was wonderful! I met with Dr. Sue Ann and was made to feel comfortable. I felt like I was important to her and her staff, and that they would stick with me until I was satisfied that my hearing issues were resolved. Everyone was friendly, professional, patient, and genuinely concerned about my situation and resolving my issues. I was floored at the difference the hearing aids made! The devices had a feature to help me cope with the tinnitus and I quickly realized I had been missing out on so much because my hearing was definitely not what it needed to be and could be. The “quality of life” thing exists and was so vastly improved after getting tested and fitted for hearing aids. And I actually was able to afford them! Holland Hearing had payment options that fit my financial life perfectly. If you’re considering visiting Holland Hearing Center, I would say that you would not find a better group of hearing professionals anywhere else. I had experience in Abilene and in Dallas with other audiologists and their staff were not at all positive. Holland Hearing was outstanding in all elements of what I expected from the experience. Anyone in this area who has any concerns about their hearing needs to drop everything and get an appointment with Dr. Mangrem or Dr. Holland as soon as they can. You will be absolutely pleased with the results.

Bill
Bill says ‘don’t hesitate to make an appointment’.

I developed tinnitus after military service and tests showed I had general hearing loss. I realized I was having issues hearing when in crowded places and hearing consonants in particular.

I had heard from many people how great the team was at Holland Hearing Center and my impressions have been very positive too. I now enjoy music and conversations much more and don’t have to ask people to repeat things.

My advice to anyone concerned about their hearing would be ‘don’t hesitate to make an appointment – in fact why aren’t you on the phone making one right now!’

‘My family are delighted, and so am I’ – Mr. Bowen’s story
Mr. Bowen first recognized he had a hearing loss while at work a number of years ago. “I was in business meetings and realized I was not really hearing everything I needed to hear,” he says. Initially, he didn’t think a specialist would be able to treat this issue. Like most, he felt it was a problem that everyone had to just deal with as they get older. In any case, he decided to speak to someone at Holland Hearing Center. “This was many years ago when they first opened,” he says. Dr. Kelsi Mangrem assessed his hearing and came up with a solution – advanced hearing technology that would effectively treat his condition. As soon as he left, he witnessed a dramatic change in his experience. And today, he benefits from a range of accessories that are improving his life even further. “Now I can control my hearing aids with my smartphone and use them in ‘restaurant mode’ to reduce background noise,” he says. “I like that they can be updated remotely, and Holland Hearing’s follow up service is great.” But just as important, his work and home life has benefitted from his original decision to see a doctor of audiology. “My business associates, as well as my family, have noticed how much better I am at hearing and are delighted,” he says, adding: “and so am I.” Have you had issues hearing those around you, or know someone else who has? Why not request a call back or write to us with a question, and we can help you today!

A D Bowen
Being a musician is extremely taxing on your hearing…
“I’m a singer and I’ve sung I don’t know how many times in Abilene over the last 30 years. I came here for my most important stop, Holland Hearing Center. I have severe hearing loss from loud music and shooting guns. I hope if you have hearing loss that you should take my word, I could go anywhere in the world, I choose to come to Abilene to Holland Hearing Center.”

Gary Morris – Legendary Country Artist
I recommend Holland Hearing Center to everyone!
I lost my hearing aid whilst out walking. I managed to find it but it was in very bad shape, I brought it back to Holland and after 15 minutes their technician had it back in tip top shape! I was so relieved, and so grateful that the service was free, I recommend Holland Hearing Center to everyone!
Jacqueline Vardiman
Janet No Longer Has to Have the TV So Loud!Janet Shares Her Difficult Previous Experiences and How Holland Hearing Helped

I remember the ringing in my ears started about five years ago. I didn’t know what was causing it so I booked a visit to Holland Hearing Center. My first impression was what friendly staff they had. I can now hear much clearer and don’t have the TV so loud!

Getting help is simple and easy and very rewarding.
It has been over six or seven years ago that I began to realize that I had issues not only with hearing loss but tinnitus as well. My greatest reluctance was with the actual wearing of the hearing aid. As I am very active in ranching and outdoor activities, I anticipated that wearing a hearing aid would be a hindrance to my work and lifestyle. While some adjustment is necessary, I certainly feel the benefits outweigh the adjustment. I first addressed my hearing loss with another specialist with whom I was very pleased but after wearing the device for approximately 5 years, I lost one and had to seek out someone new. I had heard of Holland Hearing and decided to approach them with my needs. They were very attentive to my past experience and aggressively addressed my current needs, showing the new advances in hearing aid therapy and technology. It has been a blessing to have the newest and best technology available and with the knowledge of Dr. Holland, it has been a great improvement to my hearing needs. For the first timer addressing a hearing problem, getting help is simple and easy and very rewarding. The staff at Holland Hearing Center treat you like family and "listen" to what you are experiencing and just "fix" it! Don't wait. Don't wait. The process of improving one's hearing is so painless and satisfying that there is no point in putting off being a better hearing-listener and improving your quality of life.
Joe Bob Smith
I don’t feel complete without my hearing aids
A friend of mine asked me when I was going to get some hearing aids, I realized that if others were noticing my hearing loss then I needed to take the first step towards getting help. I was a little nervous but first impressions during my visit couldn’t have been any better. Having hearing aids has impacted my life tremendously, if I forget to put them on I now don’t feel complete! I’d recommend that anyone concerned about their hearing should go to Holland Hearing Center.
Linda Newhouse
‘A wonderful, professional, personalized service’ – Noel’s story
Like a lot of people, Noel was aware that his hearing had been fading for years. But he hadn’t done anything about it. For a variety of reasons, hearing loss can be a difficult health issue to confront. It’s not something that’s frequently discussed in public – and often close family members are the first to recognize there’s a problem. In Noel’s case, he wasn’t sure where to seek help or who would be the right person to address his particular concerns. But this changed instantly when he met Dr. Sue Ann Holland. “She was so caring, competent, and considerate that I wished I had visited her earlier,” he says. In particular, he valued the way Dr. Holland tailored his treatment directly to his needs, using her expert knowledge to uncover his hearing problem. "It was a wonderful experience; a professional, personalized service – and that’s ideal!” he says. The treatment that Dr. Holland offered him made a huge difference to his life experiences and, in particular, the way he was able to interact with loved ones. “Now that my hearing deficit has been solved, I’m not missing out on conversations anymore!” he says. Today, Noel has a simple message for any future patients with worries: “Anyone doubting their hearing should head for Holland Hearing!” he says. Are you concerned about a hearing loss, or know someone else who is? Why not request a call back or write to us with a question, and we can help you today!

Dr. Noel Chant
Pat's quality of life has been vastly improved
I noticed that I was having trouble with my left ear whilst on the telephone. I had been elsewhere for hearing care but found Holland Hearing Center to be much better. My quality of life has been vastly improved and I would recommend anyone to go and experience the help I have received for themselves.
Pat Kent
How Hearing Loss Was Impacting Richard ImgrahamRichard’s Advice for Anybody That Thinks ‘Hearing Aids are for Old People’
I first noticed that I might have a hearing loss when my wife said I never listen anymore. I had noticed some ringing in my ears and some tone loss but prior to my appointment with Holland Hearing Center, I believed my hearing loss was just a part of getting old and that hearing devices were too intrusive and annoying for me to be comfortable with them (which I now know not to be true – I barely notice they’re there unless I fidget with them). My experience at my first appointment was awesome. I had decided to address my issue with a new attitude – be honest and accept the inevitable. I did not realize that I only had a certain frequency loss. The enhancement of that is amazing. Wearing hearing aids means that I can now comfortably play and listen to music. I’m so amazed at the difference in the sound quality I can hear. And as for my wife, she loves me more because I am not ignoring her unintentionally. Because they are Bluetooth connected to my phone, I can better listen to phone calls, the radio, sports, and even meditation therapy. My advice to you is that hearing aids are not just for old people. Everyone at any age needs the most optimal capability of any of our senses given to us by God. Vision, dental, or even hearing. Holland Hearing understands this and I found them to be very patient and educational. Please don’t short yourself on the best quality of life. Richard
How Holland Hearing has changed Santiago's life
“My hearing loss journey started when I first heard ringing in my ear, my biggest concern was not being able to find treatment but my experience at Holland Hearing finally found an answer. Dr. Kelsi Mangrem explained everything and answered all my questions. She was very patient with me and made sure that I understood everything about the hearing loss. Straight away, I could see the difference and it has totally changed my life, not being able to hear was very frustrating and I didn’t realize how much of a difference the hearing aids would make, I totally love them. I totally recommend Holland Hearing, the staff is super friendly and they work with you.” Santiago Cano