Audiological Referral Request 2024-25
Please complete the requested information in order to have the child/student's name added to the audiological referral database.  Following approval, the Millard scheduling secretary will contact the parent(s) to arrange the appointment. Results will be sent to the requested professional upon completion.  This process IS NOT for Millard Public or Omaha Public residents;  Millard residents should contact Millard directly and Omaha Public residents should contact Omaha Public Schools for an evaluation appointment.

REMINDER:  this is not to be used as a medical follow-up evaluation; that is the responsibility of the medical professionals.  This is for educational concerns presented by educational professionals.
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Are you a Millard Public or Omaha Public resident requesting an audiological evaluation for your child? *
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This form was created inside of Educational Service Unit #3. Report Abuse