Triage Questionnaire for Hearing Appointment

Before you can book yourself in for an appointment to visit our clinic we need to check a few things with you.

These additional checks are related specifically to the Covid-19 coronavirus pandemic. We have certain responsibilities in these unusual times and we want to ensure the health and wellbeing of our clients and ourselves.

The initial information we need to gather is as below, once you submit you will receive an email confirming the information you have submitted and we will be in touch by return to make arrangements.

If the form is not working, or you just want an initial chat, please contact us directly.

Please use this field to supply us with any supporting information you think is relevant. eg that you or someone in your household / bubble has been advised to shield for medical reasons.
N.B. This form collects your name, postcode, email address and phone number so we can communicate with you and provide help. Please check out our Privacy Policy to see how we protect and manage your details.