Onsite Vision and Hearing Services Consent Forms

Park Place Senior Rehabilitation is pleased to announce a collaboration with the Friendship Hearing Aid Center and with Mobile Vision Care, Inc., to provide onsite audiological and eye care services to our residents. Residents and essential caregivers are asked to download and complete the appropriate form(s).

ImageThe Friendship ear care program combines ear healthcare and audiological hearing services.If determined that significant hearing loss is present, Friendship Hearing will assist with the fitting, dispensing and follow-up maintenance of a hearing aid. Treatment other than routine follow-up is discussed to select the best course of medical care. | Friendship Hearing Consent Form*

Image: Mobile Vision Care LogoThe Mobile Vision Care program includes the management of eye diseases related to diabetes, cataracts, glaucoma, and macular degeneration. It also includes screening for complications associated with the use of high-risk medications such as Potiga®, Seroquel®, or Plaquenil®. Mobile Vision Care doctors provide dilated eye exams, refractions, and ongoing care. | Mobile Vision Care Consent Form*

Completed forms should be returned to the attention of Park Place Social Worker Esther Moscaira, by:

  • Faxing it to: 903-592-1088;
  • Hand delivering it to our facility;
  • Emailing it to: Social@ParkPlaceTyler.com; or,
  • Sending via U.S. Mail to our facility: 2450 East 5th Street, Tyler, TX 75701.

For additional information or questions, please contact Esther Moscaira, LBSW, at: 903-592-6745, or by an email to: Social@ParkPlaceTyler.com.

* NOTE: Adobe Reader® is required to view these forms.