{"id":9,"date":"2024-08-05T14:04:26","date_gmt":"2024-08-05T13:04:26","guid":{"rendered":"https:\/\/www.forms.nhs.scot\/audiology\/?page_id=9"},"modified":"2024-11-05T18:00:18","modified_gmt":"2024-11-05T18:00:18","slug":"home","status":"publish","type":"page","link":"https:\/\/www.forms.nhs.scot\/audiology\/","title":{"rendered":"Home"},"content":{"rendered":"\n<div class=\"wp-block-nhsblocks-card1 nhsuk-grid-column-width nhsuk-care-card nhsuk-care-card--type is-style-warning-callout\"><div class=\"nhsuk-care-card__heading-container\"><h3 class=\"nhsuk-care-card__heading\"><span><span class=\"nhsuk-u-visually-hidden\">Non-urgent advice: <\/span><span class=\"nhsuk-care-card__heading-text\">Note<\/span><\/span><\/h3><span class=\"nhsuk-care-card__arrow\" aria-hidden=\"true\"><\/span><\/div><div class=\"nhsuk-care-card__content\">This order form is only for the use of <strong>Ayrshire &amp; Arran residents<\/strong> who have been supplied and fitted with hearing aids by NHS Ayrshire &amp; Arran&#8217;s Audiology Service.<br\/><br\/>Please use this form to order replacement batteries, tubing and other consumables as required.<br\/><br\/>Your order will be recorded in your Audiology Patient record.<\/div><\/div>\n\n\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var 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novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_2' class='c-form-list gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible nhsuk-form-group\"  ><legend class='nhsuk-label gform-field-label' >Do you live in Ayrshire &amp; Arran?<\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_2_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_18' type='radio' value='Yes'  id='choice_2_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_2_18_0' id='label_2_18_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_2_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_18' type='radio' value='No'  id='choice_2_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_2_18_1' id='label_2_18_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/fieldset><div id=\"field_2_19\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible nhsuk-form-group\"  >Unfortunately this order form is only for residents who live within NHS Ayrshire &#038; Arran.\n\nFor information on replacing hearing aid consumables, please visit your local NHS Scotland Health Board website.<\/div><div id=\"field_2_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible nhsuk-form-group\"  ><label class='nhsuk-label gform-field-label' for='input_2_17'>CHI Number<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_2_17' type='text' value='' class='large nhsuk-input '  aria-describedby=\"gfield_description_2_17\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_2_17'>This is your unique NHS number in Scotland \nand can be found on your yellow hearing aid battery &#038; service book underneath the \nbarcode on the front of your book.<\/div><\/div><fieldset id=\"field_2_14\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible nhsuk-form-group\"  ><legend class='nhsuk-label gform-field-label nhsuk-label_before_complex' >What do you require?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox nhsuk_checkbox ' id='input_2_14'><div class='gchoice nhsuk-checkboxes__item gchoice_2_14_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_14.1' type='checkbox'  value='Batteries'  id='choice_2_14_1'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_2_14_1' id='label_2_14_1' class='gform-field-label gform-field-label--type-inline'>Batteries<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_2_14_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_14.2' type='checkbox'  value='Tubing'  id='choice_2_14_2'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_2_14_2' id='label_2_14_2' class='gform-field-label gform-field-label--type-inline'>Tubing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_2_14_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_14.3' type='checkbox'  value='Domes'  id='choice_2_14_3'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_2_14_3' id='label_2_14_3' class='gform-field-label gform-field-label--type-inline'>Domes<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_5\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible nhsuk-form-group\"  ><h2 class=\"gsection_title\">Batteries<\/h2><div class='gsection_description' id='gfield_description_2_5'>You will be supplied with two packets of batteries for each hearing aid that you have.<\/div><\/div><div id=\"field_2_7\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible nhsuk-form-group\"  ><h2 class=\"gsection_title\">Tubing<\/h2><div class='gsection_description' id='gfield_description_2_7'>You will be supplied with tubing, slim tubes or receivers depending on the type of hearing aids you have.<\/div><\/div><div id=\"field_2_9\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible nhsuk-form-group\"  ><h2 class=\"gsection_title\">Domes<\/h2><div class='gsection_description' id='gfield_description_2_9'>Some hearing aids are fitted with earmoulds, others are fitted with slim-tubes or receivers. If you have earmoulds you can ignore this section, this is only for those who have slim-tube or receiver type fittings\nYou will be supplied with two domes for each hearing aid.<\/div><\/div><div id=\"field_2_15\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible nhsuk-form-group\"  ><h2 class=\"gsection_title\">Delivery<\/h2><\/div><div id=\"field_2_13\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible nhsuk-form-group\"  ><p>Please allow 7-working days for delivery from date of receipt of your order noting that \ngoods are despatched using 2nd class post and that at busy times of the year such as \nChristmas, delivery may take longer.<\/p>\n<p>Orders received after midday will be processed \nthe following day. Orders are not processed at weekends so if sent at that time will be \nprocessed the following Monday.<\/p>\n\n<p>Please refer to other areas of our website for information on hearing aid repair \nservices.<\/p><\/div><fieldset id=\"field_2_16\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible nhsuk-form-group\"  ><div class=\"nhsuk_checkboxes\"><legend class='nhsuk-label gform-field-label nhsuk-label_before_complex' >Consent<\/legend><div class='ginput_container ginput_container_consent nhsuk-checkboxes__item'><input name='input_16.1' id='input_2_16_1' type='checkbox' class='nhsuk-checkboxes__input' value='1'  aria-describedby=\"gfield_consent_description_2_16\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label nhsuk-label nhsuk-checkboxes__label\" for='input_2_16_1' >I agree to the privacy policy.<\/label><input type='hidden' name='input_16.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_16.3' value='1' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_16' tabindex='0'>Any information, which you provide via this form is not made available to any third parties. 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