EVERYTHING ATHENS - Diles Hearing Center Please fill out the following information and we will be in touch to set up your appointment! Question Title * 1. Name Question Title * 2. Phone Number Question Title * 3. Email Address Question Title * 4. Preferred method of contact Phone Email Question Title * 5. The hearing screening is free, however, if we know your insurance ahead of time, we can let you know if you have an insurance benefit or not for hearing aids. This question is optional. Anthem MediBlue Medigold Anthem Blue Cross Blue Shield Medical Mutual Medicare Medicaid/Medicaid community plan United Mine Workers Other (please specify) Done