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Name:*
Email:*
Phone:*
How old is the user?:*
You already have hearing aids?:*
Yes
No
Did the doctor recommend you hearing aids / check your hearing?:*
Yes
No
How much hearing loss is felt in life?:*
Hardly
Moderately
Highly
In what types of situations do you experience difficulties?:*
Conversations one on one
Conversations in the group
Communication with young children
Conferences / Church / Concert
How long ago began to be observed hearing loss?:*
Up to 6 months
From 1 to 3 years
From 3 years to 5 years
More than 5 years
How important is the appearance / size of the hearing aid for you?:*
Never mind
Important
Very important
How does the hearing loss?:*
In one ear
In both ears
Difficult to answer
To find the best hearing aid for you, tell us your desired budget.:*
Up to 5000 UAH (Basic)
Up to 10000 UAH (Comfort)
Up to 20000 UAH (Premium)
More than 20000 UAH (Hi-Ehd)
Comments:
