(All fields required)
Please enter a valid email.
Please enter your name.
Staff members of the Cochlear Implant Program at Cincinnati Children’s Hospital Medical Center want to make it as easy as possible for healthcare professionals referring patients into our program. Below you can access a referral form and an educator’s cochlear implant evaluation.
Download these documents in portable document format (.pdf):
The Cochlear Implant Program provides healthcare professionals with a patient referral form and evaluation information.
3333 Burnet Avenue, Cincinnati, Ohio 45229-3026 | 1-513-636-4200 | 1-800-344-2462 | TTY: 1-513-636-4900
New to Cincinnati Children’s or live outside of the Tristate area? 1-877-881-8479
© 1999-2014 Cincinnati Children's Hospital Medical Center