Micro Suction Wax Removal Consent Form

Please complete this form once you have booked your ear wax removal appointment.

Fields marked with an * are required.

The purpose of micro suction is to safely remove any wax or foreign bodies present within the ear canal. To ensure this process is safely carried out it is important that the clinician is made aware of anything which may have a bearing on the procedure.

Please answer these questions regarding your hearing health;

You can update your contact preferences at any time by the following methods: www.lisagrahamhearingcare.co.uk, email info@lisagrahamhearingcare.co.uk, phone 07421 707660. Your contact preferences will be updated within 1 month of receipt of your request.