Refer Your Patient

Please fill in the form below to refer your patient and we will get in touch with the patient directly to organise an appointment. If you would like us to discuss their case with you directly, please advise us in the comments box and we will respond accordingly.

If your patient has experienced sudden hearing loss, please call 0800 345 002 to arrange an immediate appointment.

Patient Name*
Prefix First Last
Date of Birth*
DD slash MM slash YYYY
NHI (if available)
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Patient Phone*
Patient Mobile
Preferred Clinic
Referrer's Name
Title First Last
Practice or Clinic Name
Notes/Comments
File
Max. file size: 64 MB.
Please upload any supporting documents if necessary.

MAKING IT EASY

PATIENT REFERRALS

Referring your patients to Dilworth Hearing is easy. There are multiple referral options available as follows:

Medtech Connected Care
Manage My Health
ERMS
Email: gp@dilworth.co.nz
Dilworth Hearing GP voucher – Free Full Diagnostic Hearing Assessment for your patients (usually $120).
GP referral form – download here

If you would like to order GP vouchers for your patients, please contact us at 0800 345 002 or email gp@dilworth.co.nz and we will send some to your practice.

When to refer

If you are unsure whether you should refer a patient, feel free to use our Hearing Handicap Inventory (HHI) questionnaire.

The HHI screening questionnaire is used to assess a patient’s hearing difficulties, determining whether hearing loss is present and to what extent it is affecting a patient’s quality of life.

It’s made up of 10 questions about how patients cope with hearing in common daily situations. Results do not indicate the degree of hearing loss, but the perceived level of hearing issues.

Advantages of using the HHI as a screening tool:

Quick and easy to use, both for you and the patient
No specific training is required to accurately use the questionnaire
Patient can fill out the questionnaire independently
The results of the questionnaire gives a good indication on how motivated patients are to improve their hearing.
If your patient scored 10 or more on the questionnaire, we would recommend that you refer them onto us for further investigation into their hearing concerns.

Click here to download the HHI form and refer your patient (if required) through the form below or the above contact methods.

Referral Process

When you have referred a patient to us, Dilworth Hearing undertakes the following process:

Patient will be booked in for a full diagnostic hearing assessment
If hearing loss is found, we will have a consultation to discuss hearing treatment and funding options. Or if required the audiologist will refer on to an Ear, Nose and Throat specialist

In the event that your patient would benefit from hearing aids, we will provide them with a 60-day money-back guarantee on all hearing aids including free adjustments over this two-month trial period.

Email us

gp@dilworth.co.nz

Call us now

0800 345 002