Primary Care Specialist Audiology/ Hearing Aid Service

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You have been asked to fill in this questionnaire because you have been sent an appointment to see the audiologist at Northgate Medical Practice.

Your feedback is extremely valuable and would be greatly appreciated. This is a service that has been set up in order to reduce the time that you have to wait to see the audiologist, and to improve access to this service.

Your comments will help us to continue to develop and improve services so please tyr to complete this as fully as possible. This questionnaire will remain anonymous and your subsequent treatments will not be affected by your response.

Waiting Time
Appointment Experience
Age Group

It would help us to ensure that we have collected the views of all our patients if you could provide us with the following information.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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