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Newborn Screening Ontario
Hearing Loss Risk Factor Screening

Request Risk Factor Screening Results

1 Start 2 Complete

Please fill out the form below if you would like to request a baby’s risk factor screening results for Permanent Hearing Loss (CMV and genetic risk factors).

For the privacy and protection of this child, this form must be completed by the child's parent, guardian, or health care provider. Results will be released to the health care provider you list below.

If you are a health care provider and you would like to request additional testing for a child with confirmed or suspected cCMV, or Permanent Hearing Loss, please contact us. Alternative, you could visit our Forms page for further information, including the appropriate requisition.

Who is completing this form?
Child's Information
Mother's Information
Child's Health Care Provider


Call NSO : 1-877-NBS-8330 (1-877-627-8330) 

(613) 738-3222

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