Laura O. Robertson, Au.D

Doctor of Audiology

(603) 528-7700 • Toll Free (800) 682-2338
Fax (603) 528-9623

211 South Main Street
Laconia, New Hampshire 03246


New Patient Forms


We Want Time to Hear Your Concerns

In order to allow you the fullest amount of time to converse with the audiologist about your hearing concerns, it is recommended that all new patients complete the forms provided in this section prior to their initial visit. You may also call our office if you would like these forms mailed to you.

forms Tending to these forms in advance will also allow you more time to gather the information requested and seek help from a family member if necessary.

All forms can be returned by regular mail at the address provided at the top of this page, by emailing them to , or dropped off anytime at our office.

Forms are in pdf  PDF format which requires Adobe Acrobat Reader to view.
Click here to download free software.


The Value in Choosing Audiology Specialists
Patient Information Sheet
Patient Health Questions
Marketing Release
Hearing Challenges
Fall Risk Questions
Adult History Questionnaire
Policies & Procedures
Acknowledgement of Receipt of Policies & Procedures


"I have been impressed with the care and service I receive from Dr. Robertson at Audiology Specialists, LLC. I was recently told by my friends that it was very nice to no longer have to repeat themselves to me."

-Bruno Siniscalchi, Moultonboro, NH


211 South Main Street • Laconia, New Hampshire 03246

(603) 528-7700 • (800)

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