Appointment Booking Form

Preferred Appointment*

Date

Hour MinutesAM/PM Option

Preferred Clinic*

Do you have any of the following?*

Blue Pension CardDVA Gold CardDVA White Card (Hearing Loss)None of the above

You may be eligible for fully subsidised services through Hearing Services Program by the Department of health & aging, please provide details of your requirements and one of our team members will be in touch with you to book an appropriate appointment

Name*

First NameLast Name

Phone Number*

02 1111 1111

Email*

example@example.com

Date of Birth*

Date

Appointments *

Ear Wax RemovalIf you are feeling a blocking sensation in your ears, then this appointment may be helpful. We recommend you use ear wax removal softener a week prior to booking this appointment. Upon examination if no wax found, your audiologist will perform some tests to find out the possible cause for the blocking sensation and guide you for further treatment.

$95.00AUD Payment Options
Item subtotal:$0.00AUD

Hearing EvaluationComprehensive hearing evaluation (may take up to 90 minutes). In this appointment your audiologist will discuss any issues you have with your ears or hearing. They will perform video otoscopy to see how your ear health looks. If needed they may advice for wax removal. They will perform various tests related to your hearing, speech understanding and status of your middle ear. After evaluation audiologist will then explain your results to you and provide you information about the next steps to preserve your hearing and address your hearing needs with tailored solutions.

$130.00AUD
Item subtotal:$0.00AUD

Tinnitus EvaluationIf you are getting and ringing or buzzing sound in your ears, this is the appointment you need to book. This appointment can last up to 90 minutes where your audiologist will take a detailed case history, test your hearing and be able to match the pitch and loudness of your tinnitus. They will also do a few tests to understand the severity of your tinnitus. They will also be able to advise you of the next steps how you can manage your tinnitus better or any further referrals required.

$200.00AUD
Item subtotal:$0.00AUD

Total

$0.00AUD

Payment Methods

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