Wessex Hearing Centre

1 Ashley Road
Parkstone
Poole
Dorset
BH14 9BS

Telephone: 01202 722223
Fax: 01202 245222

Email:
hear@wessexhearing.co.uk


 

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Questionnaire

Please let us know something about your requirements by answering these simple questions:

Do you have difficulty hearing when in a group?     Yes No
Does your family say that you have the T.V. loud?     Yes No
Do you feel words are not clear?     Yes No
Do you ask people to repeat?     Yes No
Have you had a hearing test before?     Yes No
If the answer to the previous question was 'yes', was it NHS or private? N/A NHS Private
Do you currently have a hearing aid? No NHS Private
Do you wear your hearing aids?     Yes No
If the answer to the previous question was 'yes', do you wear them most of the time ('Most') or all of the time ('All') N/A Most All
Would you like us to arrange an appointment? N/A AM PM
   

(Items in bold are required fields.)