Health Assessment and Screening


Vision and Hearing

Vision Screening Roster - PDF
Hearing Screening Roster - PDF
Vision Rescreening Roster - PDF
Hearing Rescreening Roster - PDF
Vision Conservation Annual Report - PDF
V-4, Vision Examination Report - PDF
Treating Physician's Report - PDF
Hearing Conservation Annual Report - PDF
Audiogram Form - PDF

Eye Examination Report - PDF
Eye Examination Waiver Form - PDF

Hearing Instrument Consumer Protection
A Hearing Instrument Can Be a Good Sound Investment Brochure (En Español) - PDF
A Hearing Instrument Can Be a Good Sound Investment Poster (En Español) - PDF
A Hearing Instrument Can Be a Good Sound Investment Info Sheet (En Español) - PDF
Dispenser License Application Form - PDF
Dispenser License Correction Form - PDF
Dispenser Inactive Status Request Form - PDF
Hearing Instrument Complaint Form - PDF

Hearing Instrument Dispenser Licensure Forms
Hearing Instrument Business Disclosure Statement - PDF
Examination Registration - PDF
Hearing Instrument Dispenser Inactive Status Request - PDF
Initial Dispenser License Application Packet - PDF
Dispenser License Modification Form Packet - PDF
Dispenser License Renewal Application - PDF
Reciprocity License Application Packet - PDF
Trainee License Application - PDF




Genetics and Newborn Screening





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idph online home

Illinois Department of Public Health
535 West Jefferson Street
Springfield, Illinois 62761
Phone 217-782-4977
Fax 217-782-3987
TTY 800-547-0466
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