Did you serve in the UK Armed Forces on or after 15 May 1987?

Select one answer

Yes No

Have you previously made a hearing loss or tinnitus claim?

Select one answer

Yes No

What hearing problems are you experiencing?

Select all that apply

Hearing loss / reduced hearing Tinnitus / ringing or buzzing Difficulty hearing conversations Other hearing problems

What do you believe caused your hearing problems?

Select all that apply

Aircraft / helicopter noise Vehicle / engine noise Gunfire / artillery fire Mortars Explosions / blasts Pyrotechnics Machinery / equipment noise Other

Which branch did you serve in?

Select all that apply

British Army Royal Navy Royal Air Force (RAF) Royal Marines Other

Have you visited a GP or hearing specialist about this?

Select one answer

Yes No

Dates of service

If you are unsure, give your best estimate.

From (DD/MM/YYYY)

Day

Month

Year

To (DD/MM/YYYY)

Day

Month

Year

Still Serving

What environments did you serve or work in?

Select all that apply

Were you provided hearing protection during loud noise exposure?

Select one answer

Yes No Sometimes Cannot remember

When did you first notice hearing problems?

Select one answer

During military service After leaving the Armed Forces Not sure

Your contact details

We need your details so a member of the team can contact you about your enquiry.

First name

Last name

Address line 1

Address line 2 (optional)

Town or city

Postcode

Email address

Phone number

A UK mobile or landline number

Date of birth

Day

Month

Year

MoD service number (optional)

Optional. Leave blank if you do not know it.

Read the Privacy Policy (opens in a new tab)

I have read the Privacy Policy and understand that Lains Commercial Ltd, trading as Military Hearing, will use the details I provide to handle my enquiry.

I explicitly consent to Lains Commercial Ltd processing the information I provide about my hearing, health and medical consultations for the purpose of reviewing my enquiry and arranging a potential introduction to Lincoln Lewis Solicitors. I understand I can withdraw this consent by contacting lainscommercials@gmail.com.

I agree that Lains Commercial Ltd may share my enquiry and relevant health information with Lincoln Lewis Solcitors so that the firm can contact me about possible legal services. I understand the firm will provide its own privacy information.

I would like Military Hearing to send me information about its services by email.

I would like Military Hearing to send me information about its services by SMS.

I would like Military Hearing to send me information about its services by telephone.

No solicitor is instructed by submitting this form.