--- title: "Patient Intake Form — Z Audiology, Boca Raton" description: "Request an appointment at Z Audiology in Boca Raton, FL. Share a few details so our team can prepare for your visit — we follow up within one business day." lang: en json-ld: | { "@context": "https://schema.org", "@graph": [ { "@type": "WebSite", "@id": "https://zaudiology.com/#website", "url": "https://zaudiology.com/", "name": "Z Audiology", "publisher": { "@id": "https://zaudiology.com/#org" }, "inLanguage": "en-US" }, { "@type": [ "MedicalOrganization", "MedicalBusiness", "LocalBusiness" ], "@id": "https://zaudiology.com/#org", "name": "Z Audiology", "image": "https://zaudiology.com/og.jpg", "logo": "https://www.zaudiology.com/logo.svg", "url": "https://zaudiology.com/", "telephone": "+1-561-931-2428", "email": "drchanazelenko@gmail.com", "priceRange": "$$", "currenciesAccepted": "USD", "paymentAccepted": "Cash, Credit Card, Check", "address": { "@type": "PostalAddress", "streetAddress": "5458 Town Center Rd, Suite 4", "addressLocality": "Boca Raton", "addressRegion": "FL", "postalCode": "33486", "addressCountry": "US" }, "geo": { "@type": "GeoCoordinates", "latitude": 26.3683, "longitude": -80.1289 }, "areaServed": [ "Boca Raton, FL", "Delray Beach, FL", "Boynton Beach, FL", "Highland Beach, FL", "Deerfield Beach, FL", "Parkland, FL", "Coral Springs, FL" ], "openingHoursSpecification": [ { "@type": "OpeningHoursSpecification", "dayOfWeek": [ "Monday", "Tuesday", "Wednesday", "Thursday" ], "opens": "09:00", "closes": "17:00" }, { "@type": "OpeningHoursSpecification", "dayOfWeek": "Friday", "opens": "09:00", "closes": "12:00" } ], "medicalSpecialty": "Audiology", "founder": { "@type": "Person", "name": "Dr. Chana Zelenko, Au.D.", "jobTitle": "Audiologist", "identifier": { "@type": "PropertyValue", "propertyID": "NPI", "value": "1881311694" } }, "sameAs": [ "https://www.instagram.com/zaudiology/", "https://www.zaudiology.com" ] } ] } --- [](/) [Services](/services)[Free Tools](/tools)[About](/about)[Hearing Aids](/hearing-aids) [(561) 931-2428](tel:+15619312428)[Book a Visit](/intake) [← Back home](/) # Patient Intake Share a few details and our team at Z Audiology will follow up to confirm your appointment. This short intake helps us prepare — we'll collect full medical history before your visit. Full name Phone Email Preferred contact method Phone Email Reason for visitSelect a reason Preferred appointment datePick a date (optional) Notes (optional) This is a short intake. We'll collect a full medical intake before your appointment. Request Appointment ## Z Audiology Boca Raton, FL - [5458 Town Center Rd, Suite 4 Boca Raton, FL 33486](https://maps.app.goo.gl/46FdTQGiXWPT7nWj9) - [(561) 931-2428](tel:+15619312428) - [drchanazelenko@gmail.com](mailto:drchanazelenko@gmail.com) - Mon – Thu: 9 AM – 5 PM Friday: 9 AM – 12 PM Sat – Sun: Closed Prefer to talk to a person? Call us at [(561) 931-2428](tel:+15619312428) and we'll get you scheduled. ## What happens after you submit this form Within one business day, a member of our team will reach out by your preferred method — phone or email — to confirm the reason for your visit, offer appointment times that fit your schedule, and answer any questions about pricing, parking, or what to bring. Z Audiology is a private-pay practice, which means we don't negotiate care around insurance quotas and we can give you a transparent estimate before you commit to anything. If a specific service (a diagnostic evaluation, a hearing-aid consultation, a tinnitus workup, a walk-in repair) is a better fit than what you selected, we'll say so. ## How to prepare for your first visit A few things make the first appointment more useful. Bring a list of your current medications — several classes of drugs affect hearing and balance, and we want the complete picture. If you have prior audiograms, hearing-aid programming reports, or ENT notes, bring those too; comparing over time is often as informative as a single test. Consider bringing a spouse, adult child, or close friend. The people you most want to hear clearly tell us a lot about the specific listening environments where things break down, and having a familiar voice in the booth gives us a real-world benchmark. Avoid loud noise exposure for 24 hours before the appointment when you can — a temporary threshold shift from a concert, range visit, or construction site can move the numbers. ## Privacy, and what we do with your information The details you share on this form are used only to schedule and prepare for your appointment. We store the form data securely, we don't sell or share it with third parties, and we collect the full medical and audiological history at the visit itself under standard HIPAA protections. If you have accessibility needs — a wheelchair-accessible entrance, a sign-language interpreter, a family member who needs to attend by phone — mention it in the notes and we'll accommodate it. Every appointment at Z Audiology is one-on-one with Dr. Chana Zelenko, Au.D. There is no phone tree, no rotating clinician, and no rushed 15-minute slot. ## What makes Z Audiology different Two things shape every appointment on our schedule. The first is time. A standard evaluation runs 60 to 90 minutes because that's how long a real conversation about your hearing, your history, and your goals actually takes; a hearing-aid fitting includes a week-one, month-one, and month-three follow-up as part of the price because acclimatization is a process, not an event. The second is independence. We fit Starkey, Widex, Signia, Oticon, Phonak, and ReSound, and we have no manufacturer quotas or kickbacks pushing us toward one line over another. That freedom lets us match technology to your audiogram, ear anatomy, and lifestyle rather than to a corporate parent's inventory targets. Every device we fit is verified with real-ear probe-microphone measurement — the objective standard the American Academy of Audiology has recommended for decades and that a majority of dispensers still skip. ## Who we typically see Our patients arrive from across South Florida — Boca Raton, Delray Beach, Boynton Beach, Highland Beach, Deerfield Beach, Parkland, and Coral Springs — and from further afield when a seasonal move or a family recommendation brings them in. Some come because a spouse has been asking them to. Some come because a primary-care physician flagged a screening result. Some are adults with a lifetime of professional listening (attorneys, educators, musicians, executives) who want the clarity back that made them good at their jobs. Some are parents of children who didn't pass a school screening. Some have been fit elsewhere, didn't love the result, and want a second opinion from an independent audiologist. Whatever brought you to this page, the path forward starts the same way: a short intake, a return call within one business day, and an unhurried appointment in a quiet, welcoming office. Next Step ## Come in. We'll take our time with you. Book a comprehensive hearing evaluation — usually 60 to 90 minutes, and you'll leave with a clear picture of what's going on. [Start intake](/intake) [Call (561) 931-2428](tel:+15619312428) Visit the Practice ## Find us in Boca Raton. We're tucked into the Town Center Road medical village — free parking at the door, elevator access, and a waiting room that actually feels like a living room. Google Business Profile Z Audiology Audiologist · Boca Raton, FL [](https://www.google.com/search?q=Z+Audiology+Boca+Raton#lrd=0x88d922777c50fd67:0x0,1) [5 ](https://www.google.com/search?q=Z+Audiology+Boca+Raton#lrd=0x88d922777c50fd67:0x0,1) [Read Google reviews](https://www.google.com/search?q=Z+Audiology+Boca+Raton#lrd=0x88d922777c50fd67:0x0,1) 5458 Town Center Rd, Suite 4 Boca Raton, FL 33486 [(561) 931-2428](tel:+15619312428) [drchanazelenko@gmail.com](mailto:drchanazelenko@gmail.com) Hours Mon – Thu 9 AM – 5 PM Friday 9 AM – 12 PM Sat & Sun Closed [Directions](https://maps.app.goo.gl/RdocN9NJwQR8bicP8)[Call](tel:+15619312428)[View on Google](https://www.google.com/search?q=Z+Audiology+Boca+Raton#lrd=0x88d922777c50fd67:0x0,1) Z Audiology Rediscover the joy of hearing. An independent audiology practice in Boca Raton — sea-foam walls, light oak, and doctoral-level care from someone who wears hearing aids herself. Explore - [Services](/services) - [Free Tools](/tools) - [Hearing Aids](/hearing-aids) - [About Dr. Zelenko](/about) - [Hearing Health](/hearing-health) - [Reviews](/reviews) - [Statistics](/statistics) Get in Touch - [(561) 931-2428](tel:+15619312428) - [Book a visit](/intake) [Request an appointment →](/intake) © 2026 Z Audiology, LLC. All rights reserved. · Dr. Chana Zelenko, Au.D. · NPI 1881311694 [Boca Raton](/locations/boca-raton) · [Delray Beach](/locations/delray-beach) · [Highland Beach](/locations/highland-beach) · [Deerfield Beach](/locations/deerfield-beach) · [Boynton Beach](/locations/boynton-beach) · [Parkland](/locations/parkland) · [Coral Springs](/locations/coral-springs)