Patients with a Hearing Impairment Form

Section

Type of Hearing Loss:
What would help me during my appointment:
The best way to contact me is:
I would like to use the following digital technology during my appointment:

Please can you ensure this information is recorded and flagged on my patient record, in accordance with NHS England’s Accessible Information Standard.

Find out more by visiting: www.england.nhs.uk/ourwork/accessibleinfo