Cinotti Screening Program

I acknowledge that I (or my child) am voluntarily participating in a free hearing screening provided through the Cinotti Grant Program, which seeks to expand access to no cost health care screenings and services for the public through nonprofit entities.

I understand and agree to the following:

– I must provide proof of Florida residency to qualify for this free service.

– I must complete the required screening consent form prior to the hearing screening.

– I consent to have my hearing—or the hearing of my minor child—tested as part of this program.

I confirm that I have read and understood the information above and consent to participate in this free hearing screening.