This form collects notifications of children and young people 18 years or younger:
• With a permanent hearing loss in one or both ears
• An average of 26dBHL or greater over four audiometric frequencies (.5, 1.0, 2.0 and 4.0kHz)
• born in Aotearoa New Zealand or overseas

Please note we are no longer seeking information on high frequency hearing losses in children over the age of five which do not meet the average above.

The following examples may help you decide whether notification is required:
Included within the database: Atresia, congenital ossicular fixation, meningitis, acquired hearing losses.
Excluded from the database: Losses which are can be fixed by the use of grommets e.g. Otitis media.

If you are unsure as to whether to notify a particular case, please do include it and provide as much information in the space provided. We will review these to ensure the right cases are included within the database.

If you are unsure whether you or someone else may have already provided a notification about a particular child or young person, please just get in touch with Janet Digby and she will check. Her email is janet@levare.co.nz and you can reach her on 021 653 827. 

There is a box at the end of the form for you to record additional comments.

Click "Next" to get started...
 
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