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Celtic Hearing Hearing Aid Shop Swansea Carmarthen Lampeter Hearing Aid Shop Swansea Carmarthen Lampeter

01267 222283 (Carmarthen) | 01792 465297 (Swansea)

01570 421078 (Lampeter)

info@celtichearing.com

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Face to Face Appointments

Face to Face Appointment Form

Please fill out this form if you'd like a face to face appointment with us at your chosen branch.

Name*
First Last
Email
Address*
Street Address City ZIP / Postal Code
Phone*
Where did you find out about us?*
Please tick all that apply**
- I or someone in my household has contracted Coronavirus (Covid-19) within the last 14 days
- I or someone in my household has had a new, continuous cough within the last 14 days
- I or someone in my household has had a loss of taste / smell in last 14 days
- I or someone in my household has had a high temperature (37.8C or over) within the last 14 days
- I or someone in my household has been feeling unwell in the last 14 days
- I or someone in my household has been advised to shield by a health professional / authority
- I or someone in my household has been in contact with a Covid-19 infected person within the last 14 days
- I as the person needing wax removal have a perforated ear drum that is not healed
- In the last 14 days no-one in our household has had any Covid-19 symptoms or is aware of being in contact with Covid-19
- In the last 14 days no-one in our household has had a sore throat, runny nose or been suffering from headaches ?
Your preferred Branch of Celtic Hearing*
Consent
I agree to collecting info on this form (please tick to confirm consent)
If you'd like to know more about how we look after your data please see our privacy policy here.
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MAIN OFFICE

Celtic Hearing Carmarthen, 17 Lammas Street, Carmarthenshire, SA31 3AQ

01267 222283

info@celtichearing.com

SWANSEA BRANCH

Celtic Hearing Swansea, 3 Mannheim Quay, Maritime Quarter, Swansea SA1 1TS

01792 465297

info@celtichearing.com

LAMPETER BRANCH

Celtic Hearing Lampeter, 16, Bridge Street, Lampeter, Ceredigion, SA48 7AA

01570421078

info@celtichearing.com

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