All New Genesis Artificial Intelligence Hearing Aids
All New Genesis Artificial Intelligence Hearing Aids
CONSENT FORM FOR GENERAL DISPENSING
Your hearing test will be conducted by a trained HCPC Registered Hearing Aid Dispenser & Audiologist working to best practice and professional protocols.
Very often, appointments may be required for adjustments for your hearing instruments and you should contact the Audiologist if you feel this is required.
The hearing test is a non-invasive procedure. Use of an Otoscope will be required (visual inspection of the outer and inner ear).
Depending on the type of hearing instruments prescribed you may be required to have an impression taken. Soft material especially made for this purpose will be put into your ear canal. Complications from the use of an Otoscope and impression taking are uncommon. Side effects and material risks inherent in the procedure are very uncommon but it has been known that clients may get an infection of the skin of the ear canal or minor bleeding, discomfort, ringing in the ear (tinnitus), or perforation of the eardrum. There is an extremely slight risk that you may feel slight discomfort in your ear canal for a time, also if you have used implements in an attempt to remove your own wax in the past.
The highest standards of infection control are in place to minimise risks. To ensure the risk of complication is minimised, it is essential that accurate past medical history is supplied to our clinicians.
CLIENT CONSENT
I confirm by signing this document that:
• the Audiologist has discussed the risks involved.
• the Audiologist has explained the procedure.
• I have had adequate time to consider the risks detailed in this consent form and the Audiologist has answered fully any concerns I had.
• it is my responsibility to advise the Audiologist if any medical conditions change .
By agreeing to these terms and conditions, I accept that I have read and understand the possible complications that may occur and agree that the Audiologist, or any of its other employees at Vale Hearing Healthcare, cannot be held responsible for them and that I am willing to be bound by them.
Vale Hearing Healthcare will do everything in its powers to make sure we keep you safe from Covid-19. If you accept your appointment Vale Hearing Healthcare cannot be held responsible if you contract Covid- 19. You accept your appointment at your own risk and we accept to carry out the appointment at our own risk.
Client Signature:
If you need to reschedule an appointment, please call/text or email us.
Thank you for your patience and understanding during this time and as always thank you for allowing us to assist you with your hearing healthcare needs.
Copyright © 2018 Vale Hearing Healthcare - All Rights Reserved.
Welcome to Vale Hearing Healthcare.
We are open for all your private hearing healthcare needs.