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Self referral form: AQP AGE RELATED HEARING LOSS HIGHLY CONFIDENTIALBuckinghamshire and Oxfordshire Age Related Hearing Loss ServiceAUDIOLOGY SELFREFERRAL FORM (ADULTS) Please complete the two-page
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How to fill out age related hearing loss

01
Schedule an appointment with an audiologist for a hearing test.
02
Discuss any symptoms or concerns related to hearing loss with the audiologist.
03
Follow the audiologist's recommendations for treatment options, which may include hearing aids or other devices.
04
Attend follow-up appointments for monitoring and adjustments to the treatment plan.
05
Protect your hearing by avoiding loud noises and using ear protection when necessary.

Who needs age related hearing loss?

01
Individuals who are experiencing symptoms of hearing loss, such as difficulty understanding conversations, ringing in the ears, or constantly asking others to repeat themselves.
02
People who are aging and have a family history of hearing loss.
03
Anyone who is exposed to loud noises on a regular basis, such as musicians, construction workers, or hunters.
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Age related hearing loss, also known as presbycusis, is the gradual loss of hearing that occurs as people get older.
Individuals who are experiencing symptoms of age related hearing loss or are concerned about their hearing should seek evaluation and treatment from a healthcare provider.
To fill out age related hearing loss, one should consult with a qualified audiologist or healthcare provider for diagnosis, treatment, and management options.
The purpose of addressing age related hearing loss is to improve the individual's quality of life, communication abilities, and overall well-being.
Information to be reported on age related hearing loss includes the severity of hearing loss, any underlying causes, treatment options, and management strategies.
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