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Contact for Appointment

Submit the appointment interest form on this page or call (202) 683-7620 if you are interested in scheduling an appointment. To contact Audiology Outside the Box for another reason, submit the form at this link.

Name*
First Last
Email*
Zipcode*
ZIP / Postal Code
Describe your reason for requesting an online appointment*
I am interested in scheduling an appointment for:*
- Myself
- My Child
If you are requesting an appointment for yourself, please answer for yourself. If you are requesting an appointment for your child or someone else, please answer for that person. Is there an identity that you would like Dr. Sparks to know about before your appointment? Examples: Deaf, deaf, hard of hearing, Black, transgender
If you are requesting an appointment for yourself, please answer for yourself. If you are requesting an appointment for your child or someone else, please answer for that person. My languages and modes of communication are:
- American Sign Language
- Cued Speech
- Sign-supported English/sim-com
- Spoken English
- Written English
- Other (please describe below)
Is there anything else you would like Dr. Sparks to know?
Phone
This field is for validation purposes and should be left unchanged.

Contact for Appointment

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