Audiology equipment – Online repair request form – Bradford Teaching Hospitals NHS Foundation Trust

The Bradford Audiology department are pleased to be able to offer an online repair request form.

All you need to do is fill out the form below and press submit. This will be sent to an audiologist and we will complete your request within a week – please allow a few weeks for delivery. Don’t worry; we’ll never share your details with anyone else.

This form is for existing Bradford Teaching Hospitals NHS hearing aid users only

First Name*

Last Name*

Date of Birth*

Please use dd/mm/yyyy as the format. E.g: 31/01/2001

Hospital number (if known)

Find your NHS number This link provides help for finding your NHS number

Email*

Telephone number*

Address*

Please provide your full address including postcode

Items required

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Any other queries?

Are you happy for us to store your email address so we can contact you?*

YesNo