Referral Program

Do you know a friend or loved one whom you think may have hearing loss?

If so, please complete the form below and we will contact them to arrange a free, comprehensive hearing examination.

You will receive a $25.00 gift certificate to a great local restaurant for each referral who has their hearing tested with us. Be sure to include your contact information so we can send your gift certificate to you.

Thank you for helping those close to you realize how much better life is when they are able to hear!

  • Your Information:

  • Person You Are Referring Information: