Tell Us Your Story

Tell Us Your Story

Tips for entering your story online

If you are going to enter your story, we recommend you take a while to think about your experience and write it offline, then come back and paste it in the form below.

( *indicates a required field ).
First Name*:
Last name*:
Display Initials Only?	Do not use my real name, use my initials instead.
Email*:
Address 1:
Address 2:
City:
State:
ZIP/Postal Code:
Country:
Home Phone:
Hearing Loss classification:
Duration of bilateral severe-profound hearing loss:
Etiology
	Other:
Age at onset of hearing loss:
What methods of communication were used prior to hearing loss: (Select all that apply. Hold down "ctrl" and click to select more than one item.):
	Other:
Are you interested in communicating with a candidate who is currently exploring cochlear implant options? (More about this) :	Yes No
Birth Date (mm/dd/yyyy):
Implantation Age:
Please tell us your story. Type your answers in the form below. You may want to write your story offline and then come back and paste your story in the form. How long have you had your implant? Do you use a hearing aid or a bilateral cochlear implant in the other ear? Briefly describe your hearing history.= Why did you choose a Nucleus implant system? What were your experiences getting an implant (evaluation, surgery, hookup, rehabilitation, etc.)? How has the implant affected your life or your child's life? How does it compare to a hearing aid? Tell us about your auditory skills today. How important is lip-reading, do you use the phone and cell phone, enjoy music? How do you or your child function in meetings or the classroom or other noisy environments? What do you like most about the implant? What is your most memorable experience about this journey?
Check to upload a photograph of yourself: (after you submit this form, you will have a chance to select and upload your photo)
I authorize Cochlear to use and reproduce any of the above information or photographs provided.
I have read and agree to the privacy policy and terms of use.
	Submit

Tell Us Your Story

Tips for entering your story online

Please tell us your story. Type your answers in the form below. You may want to write your story offline and then come back and paste your story in the form.

I have read and agree to the privacy policy and terms of use.