Please use this form to request new batteries or hearing aid consumables. Hearing aid batteries are an expensive NHS resource. Please only request batteries if you are about to run out. We aim to post these out by Royal Mail Second Class within two weeks of receiving the request.
Please only use this form is you are a patient of the Adult Audiology service run by University Hospitals Bristol and Weston NHS Trust. We can only send replacement batteries and tubing to patients we have issued hearing aids to.
Questions marked with an asterix (*) are mandatory.
First name*
Surname*
Date of birth (DD/MM/YY)*
NHS number or T number, if known
Address*
Postcode*
Telephone number*
Type of battery required*
Do you need replacement mould tubing?*
Do you need replacement thin/slim tubes and domes?*
Do you need a cleaning wire?*
I consent to having my information stored for the purpose of this online form. I know you may need to contact me in relation to my form. I understand that if I don't consent I cannot submit online.