Who are you seeking information for? *

Myself

On behalf of someone else

Do you currently use a hearing aid? *

Yes

If inquiring on behalf of someone else, answer based on that person's circumstances.

Have you had a hearing test in the past 6 months? *

Yes

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Please upload the most recent results of your hearing test or audiogram here:

Audiogram File Upload

If you do not have the results readily available, you can skip this step for now and share with the audiology team at a later date.

Do you experience ringing or buzzing in your ears, or have you been diagnosed with tinnitus? *

Yes

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How soon are you looking to improve your hearing? *

Immediately

Within the next month

In a few months

Just exploring options

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How would you rate your current level of hearing loss? *

No loss

Mild

Moderate

Severe

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How would your family or friends rate your current level of hearing loss? *

No loss

Mild

Moderate

Severe

Not sure/not applicable

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Your story matters - share any thoughts, experiences, or background on your hearing here.

If inquiring on behalf of someone else, answer based on that person's circumstances.

First Name *

Last Name *

Phone *

Email *

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