2021 Referral Consultation forms from UnitedHealthcare Hearing

January/February 2021


We are introducing new referral forms for hearing tests and hearing aid purchases.

  • Updated Standard Patient Consult Forms for patients who are being tested and purchase hearing aids
  • New Test and Assess Referral Form for patients who are eligible for hearing assessment-only services through the virtual home delivery option, Right2You

Standard Patient Referral/Consult 

Infographic chart demonstrating processes for hearing tests and hearing aid purchases

Test and Assess Referral

Infographic chart demonstrating processes for hearing tests and hearing aid purchases