This manuscript describes a pilot project in which infants in Guam who refer on newborn hearing screening receive diagnostic audiological evaluation conducted by audiologists in Colorado over the Internet (telepractice). The evaluation is completed in real time using commercially-available software and personal computers to control the diagnostic audiological equipment remotely, and videoconferencing with support personnel and the family. Test results for 9 infants, all of whom received complete diagnostic assessment by auditory-evoked potentials and otoacoustic emissions, are described. Further elaboration is provided on steps to establishing the project and how regulatory, privacy and confidentiality, and professional practice issues in telepractice are addressed.