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Neuromod Medical Booking Assessment

GDPR Consent

Neuromod Medical are collecting your personal data, including medical data, in this pre-assessment questionnaire. This is necessary (with your consent) in order to ensure you are a potential candidate for the LenireTM device. We would not like to bring you in for an assessment (incurring fees, travel and time costs) if it is unnecessary.
We require your consent in order to gather, process and store this information.

We will use your personal data:

  • To assess whether you would benefit from, or be eligible for, an appointment at Neuromod Medical for a tinnitus assessment
  • If you proceed to attend Neuromod Medical for a tinnitus assessment with or without subsequent treatment with Lenire™, the data you provide in this online assessment will be combined with other personal information provided by you:To provide a clinical diagnosis as well as appropriate therapeutic recommendations.
    • To gather information about ongoing symptoms and device use to manage your treatment.
    • To carry out our obligations arising from any contracts entered into between you and us and to provide you with the information, products and services that you request from us.

Neuromod Medical takes your privacy seriously – our Data Privacy Notice, which outlines all information we collect about you, how we collect, use, store and delete it, can be found here. This Notice also tells you what rights you have in relation to your personal data and how you can access and control your information.

Please tick as appropriate: *This question is required.Please note, by clicking "I do not give my consent" the Assessment will end and you will not be able to proceed. 

You can withdraw your consent at any time by contacting us at:
Email: info@neuromodmedical.com
Phone: +353 1 2531448

Neuromod Medical will use the contact information you provide in this pre-assessment to contact you for the purposes of scheduling a medical assessment appointment. This contact may be made by a number of communication methods in addition to traditional correspondence:
  • by phone
  • by post
  • by email
  • by text message
  • Through digital and/or other remote application

We use SurveyGizmo to host our questionnaire and provide your information to us. You can learn more about SurveyGizmo’s privacy practices here.

If you have a query in relation to how your data is handled, you can contact us by email or phone:
Email:  info@neurommedical.com
Phone: +353 1 2531448