Please return this form before your appointment

Address: 66 Michaels Ave,, Auckland, 1051, NZ
Telephone: 09 525 0522

Contactless form

We have created this secure online so we can collect your details in a contactless way. Please fill this form in before your appointment.

You will notice there is a section about wax removal near the bottom of the form. This is a required section as in some cases we need to remove ear wax before doing a hearing test or making impressions for customer earplugs. We would like you to be informed about this process.

Contact Maree and Yvonne by:

Email: [email protected]

Call: 09 525 0522

Text/SMS: 027 808 3522

Find us at:

66 Michaels Ave, Ellerslie,

Auckland 1051

Take a look around the Auckland Hearing Clinic

Hearing assessment

Explaining the hearing test results

Our wax removal clinic

Please fill in our secure online form prior to you appointment

Full name*
Title: Ms/Mrs/Mr/Dr/Miss/Mr First Last
Caregivers details
Title: Ms/Mrs/Mr/Dr/Miss/Mr First Last
Please add caregivers details if the appointment is for a child.
Date of Birth:*
Day / Month / Year
Phone*
First
Address*
Street number and name Suburb City ZIP / Postal Code Country
Email
NHI number (if Known):
Ethnicity
Optional - Ethnicity data is collected by the Ministry of Health (MoH).
GP details:
First Middle Last
My appointment is for:*
Notes - please tell us anything you think we should know prior to your appointment
Please upload previous Audiograms or reports here (optional)
Drop files here or
Wax removal information and agreement*
I have read and understand the information provided. I understand that if I have wax removed at Auckland Hearing, I must keep my head still during the wax removal appointment.
This information is to help you understand what is involved in your wax removal appointment.

We will use an ear light system to look down your ear canal. To remove the wax, we may use a curette (a small tool to bring the wax out) or suction depending on what is needed. In some cases, we use saline to soften the wax.

During the appointment, we will be working down your ear canal with instruments, which we use to remove the wax. We need you to remain still during the procedure and not move your head. Moving your head when we have instruments in your ear canal, could be very dangerous and at worst could damage your ear-drum or ear-canal.

In some cases, having wax removed can be a bit uncomfortable, because the skin underneath the wax may be a bit fragile due to being wet for some time. We will do our best not to touch the sides of your earcanal so that the procedure is as comfortable as possible.

Please remain still during the wax removal procedure.
If you feel any discomfort during the procedure, please just say “stop”, and we will stop immediately. At no point should you move your head.
How did you find out about Auckland Hearing*
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Phone
This field is for validation purposes and should be left unchanged.

Changes at Auckland Hearing due to Covid-19

Keeping you and our community safe

Virtual appointments preferred

You will be well aware that we need to take precautions in regards to the coronavirus. In some cases, we are able to help you with a ritual appointment, either over the phone or using the Zoom platform. This is the preferred option if possible.

Appointments – When we need to see you in the clinic the following precautions are in place:

Before you come into Auckland Hearing

You will be screened for symptoms before your appointment. If you have any cold or flu symptoms or think there is a possibility you may have been exposed to the Coronavirus please do not come to your appointment, we will rebook you once you are well.
We will ask you to fill in your client information form online before your appointment.
Please wash your hands before coming to your appointment, you will also be given hand sanitizer on arrival.
If you have a face mask, please wear it to you your appointment. If you do not have a face mask, you will be provided with a face mask on arrival.

When you get to Auckland Hearing

We have set up a desk at the front of the clinic. All hearing aid repairs will be done from there. This reduces the number of people entering the clinic.
We will not be using the waiting room for more than one person at a time. If you are early for your appointment we will ask you to wait in your car and will collect you once we are ready for you.

At your appointment

We would prefer you have a maximum one support person in the clinic (please do not bring children to the clinic unless the appointment is for them).
We will be wearing PPE, including N95 masks and gloves.
We will aim to stay more than 1 m away from you as much as possible (other than when a clinic procedure means we need to get closer to you).
We ask that you avoid touching surfaces if possible.
All surfaces will be wiped down between clients.