Remote Hearing Care

1

Do you currently wear hearing aids?* This field is required.

YESNO

2

How would you rate your hearing without hearing aids?

3

What environments do you struggle to hear in most?* This field is required.We can optimise and customise the hearing aid programs for your specific hearing needs

One on one conversations

Group conversations

Restaurants/Bars

Religious Services

Conferences

Concerts

4

What is most important to you when looking for a solution for your hearing problems?* This field is required.

Discreet Looks

Affordability

Latest Technology

All

5

Have you had a hearing test recently?* This field is required.In the last 6 months

YESNO

6

How old are you?* This field is required.

7

Do you hold a pensioner concession or DVA card?* This field is required.

YESNO

8

Do you have access to a smart phone?* This field is required.Either iPhone or Android, this is required to be able to conduct the remote care sessions with your clinician.

YESNO

9

What's your name?* This field is required.

First Name

Last Name

10

What is your postcode?* This field is required.Let's see if we have an audiologist in your area.

11

Email* This field is required.We can send you some further details via your email. We take privacy very seriously and promise to never spam.

example@example.com

12

Thanks for your patience, this is the last step: What number can we reach you on to discuss your results?* This field is required.

Phone Number

13