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Title (required)

First name (required)

Last name (required)

Date of Birth (required)

Who is the point of contact for this appointment?

The patient

Someone else

What is the relationship to the person being tested? (required)

First name (required)

Last name (required)

Email (required)

Phone (required)

Address for test (required)

Address Line 1 (required)

Address Line 2

Town (required)

Postcode (required)

Country (required)

Further details (such as house directions, parking restrictions or last eye test)

We’d like to keep in touch by post, text, telephone or email with useful marketing updates, news, discounts and offers (sometimes from trusted partners) relating to your home healthcare, including but not limited to optical, hearing aids, supplements, and mobility products.

Your data security is our priority, and we will never sell your details to third parties.

By giving consent, you confirm you:

are happy to receive postal mail?

are happy to receive text messages?

are happy to receive emails?

are happy to receive phone calls?

You can opt out at any time. Our Privacy Policy explains more.

By submitting this form, you’re confirming you have permission to share these contact details and that the patient knows you're booking this appointment. We appreciate the trust you place in us when sharing your personal data, the security of your data is very important to us. All data is processed in accordance with the Data Protection Act 2018. We want to keep you informed about services and products, so we’ll contact you via the details provided. You can opt out of marketing updates or manage your consent preferences at any time by visiting our Privacy Policy You can also find further information here about how your information is processed.

OutsideClinic Hearing Aids

What appointment would you like to book?

Does the person you are booking for struggle to get to an optician on their own, for example due to mobility or health reasons?*

Who will be taking the test?

Your request was successfully submitted.

What to expect from your appointment

We take the time to get you hearing well again.

Packed full of modern technology.

Clearer, natural sound.

Your hearing loss, your lifestyle.

Don't just take our word for it!