forms

- - - - Adult Candidacy Quiz - - -

Are you a Candidate for Cochlear Implants?

Take our adult candidacy quiz (check all that apply):

	I have difficulty following conversations without lip reading.

	I hear pretty well in quiet environments, but struggle in noisy environments or when in a group.

	I cannot follow most telephone conversations, especially if I don’t know the person calling.

	I feel isolated and limited, both socially and occupationally, because of my hearing loss.

Thank you for contacting us to assist with your hearing solutions. Count on us—a community of hearing health professionals and recipients of cochlear implants—to help you Hear and Be Heard™. A representative from Advanced Bionics will be in touch soon!

If your request needs immediate attention or you have additional questions, please contact hear@AdvancedBionics.com.

Thank you for completing the cochlear implant candidacy questionnaire!

Your results show that you might be a candidate for cochlear implants. Please fill out the quick form below and a AB representative will reach out and answer any questions you may have. We can also put you in touch with individuals who have been through this process already so you know exactly what to expect. We look forward to getting to know you!

Choose the category that best describes you:

First Name

Last Name

State

Privacy Notice

I have read and agree to the Advanced Bionics Privacy Policy

AB Privacy Policy

Email

City

Zip Code

AB takes your privacy seriously. We will never sell or transfer your personal information to other companies for marketing purposes.

- - - - Child Candidacy Quiz - - -

Is your Child a Candidate for Cochlear Implants?

Take our child candidacy quiz (check all that apply):

	My child has delayed speech and language development as a result of his or her hearing loss.

	My child child rarely responds to his or her name.

	My child avoids social interaction or lacks the appropriate skills to interact with other children or adults.

	I have concerns about my child's ability to hear speech in noisy environments.

If you checked one or more of the above, then your child may be a candidate for Cochlear implants.

- - - - We're here to help form - - -

- - - - Start your own Journey form - - -

Search Suggestions

Are you a Candidate for Cochlear Implants?

Take our adult candidacy quiz (check all that apply):

Thank you for completing the cochlear implant candidacy questionnaire!

Is your Child a Candidate for Cochlear Implants?

Take our child candidacy quiz (check all that apply):

If you checked one or more of the above, then your child may be a candidate for Cochlear implants.

Thank you for completing the cochlear implant candidacy questionnaire!

We're here to help

We're here to help