Request Universal Newborn Hearing Screening Printed Material

The Ohio Department of Health, Infant Hearing Program provides printed materials to hospitals, birthing centers, local health departments and audiology facilities. Please complete the below information with the type of material and quantity.

Question Title

1. Please complete the following information to request print materials from the Infant Hearing Program

Requestor Name: *

Agency Name: *

Agency Address: *

Unit/Department/Floor:

City *

State: *

ZIP: *

Email Address: *

Phone Number: *

Question Title

2. Select the resources you wish to order and indicate the quantity. Please note, the minimum amount is 100 per material. For brochures in additional languages, please visit: https://www.odh.ohio.gov/odhprograms/ei/hear_inf/hi_brochure.aspx

UNIVERSAL NEWBORN HEARING SCREENING BROCHURE (English)

UNIVERSAL NEWBORN HEARING SCREENING (Form HEA 4632 )

OBJECTION TO UNIVERSAL NEWBORN HEARING SCREENING (Form HEA 4633)