Patient Info

Please take a few minutes to complete the following required medical forms to save time before your first visit to Helmert Hearing Clinic. 

You can complete these forms and bring them with you to your first appointment. All documents require Acrobat Reader in order to view and print.

Patient Information  

Medical History  

Health Information Release

Stacy Helmert, Au.D. CCC-A, F/AAA
860 Hwy. 62 East • Suite 8
Mountain Home, AR 72653
Local: (870) 424-4838
Toll Free: (866) 548-6537