Hearing Questionnaire

Better Hearing. Better Living.

By filling out this form, we can help and advise you of the options available to you if we find that you could have some hearing loss.

Name *

Email Address *

Phone Number *

Do you struggle to hear the TV?YesNo

Do you have problems hearing the doorbell or listening to people on the telephone?YesNo

Do you struggle in group conversation?YesNo

Do your family and friends comment or remark about your hearing?YesNo

Do you miss the beginnings or endings of words and sentences?YesNo

Do you struggle to hear female or children’s voices?YesNo

Do you find yourself feeling left out of conversations?YesNo

Do you ever find yourself trying to lip read?YesNo

Do you ever struggle to hear in a car?YesNo

Do you struggle to hear in background noise?YesNo

I have read and agree to the Privacy Policy *Yes

I want to opt in to receive email marketing.Yes

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Test Today

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ADDRESS

69 Clifton Street,
Lytham St Annes, FY8 5ER

FREEPHONE

0800 032 7697

OPENING HRS

Mon - Fri 9am - 5pm
Sat 9am - 1pm

SLM Agency trading as Lytham Hearing Centre is authorised and regulated by the Finalncial Conduct Authority (FCA) for regulated consumer activity only. Our firm refernce number is: 628952. SLM Agency is registered in England & Wales, Company Registration Numuber 05806987. You can check this on the Financial Services Register at http://register.fca.org.uk

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