Request An Appointment

If you wish to request an appointment with us, you can use the form below to send us a request. We will contact you to confirm the appointment. Please note that the appointments are not fully booked, unless we confirm it with you over the phone or via email.

Alternatively, you can call the clinic on: 043 336 8029

Name

First Name

Last Name

Phone

Please use the following format: 083 123 1234

(###)

###

####

Any Comments or Special Requests

Communication Consent

Allow Midland Hearing Care to contact you regarding your appointment or requested services