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Correspondence Courses New Enrollment Download Lessons Submit Parent Report Summer Sessions Dates Arriving in L.A. Lodging Visitor Links Summer Session Alumni Page Parent Resources Español Education Programs Parent Infant Program Preschool Parent Education & Support School Calendar Hearing Testing On-site Audiological Services Community Hearing Screening Baby Sound Check Long Beach Center   Teacher Education Program TIES Workshops Audiology Corner & FAQs Ask Our Audiologist Cochlear Implant Habilitation About JTC Contact Us Our Parents & Alumni Speak JTC News/Media Read our Bulletins Visitors Employment Opportunities Giving Guilds & Auxiliaries Upcoming Guild Events	Audiological Appointment Request Hearing Tests | Cochlear Implants at JTC | Appointment Request | Community Hearing Screening | FAQs | Ask an Audiologist | Hearing Aid Donations | Baby Sound Check To make an appointment, please fill in the following information. Child Information Child's First Name Child's Last Name Child's Date of Birth Language spoken at home Contact Information Parent's First Name Parent's Last Name Home Telephone No. (***) *** - **** Address City State Zip Country Reffered by select Regional Center Pediatrician Teacher/School District Friend Other Mayor Concern   Child's Hearing Background Sounds you think your child can hear: Speech Phone Vaccuum Cleaner Airplanes Doorbell Banging Objects Does your child follow verbal commands? Yes No If so, what are they? Is there history of congenital deafness in the family? Yes No If so, explain: Ear infections: Yes No How often? times per year   Child's Health Background Type of birth: Normal Cesarean Jaundice present at birth? Yes No List any complications at birth: Does your child have any other diagnosed health problems, or developmental concerns? Comments.   Copyright © John Tracy Clinic® 2008 disclaimer/terms of use 806 West Adams Blvd, Los Angeles, California, USA 90007-2505 (213) 748-5481 John Tracy Clinic is a Registered Trademark. All Rights Reserved.	Deaf Author Speaks to Parents Alumna Named Miss Missouri International JTC Featured on Angel Walk L.A. New Study: Meningitis vaccinations important for children with CIs Baby Sound Check® Model infant-toddler hearing screening program Become a Teacher of The Deaf (Scholarships Available) Holiday and Cultural Celebrations

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