Connect with a Mentor

Your details

First name

Last name

Email address

Mobile phone

Country code

Select

Area code and number

Post/Zip code

Your hearing loss experience

Do you have a hearing implant?

Yes

Tell us a bit about yourself so that we can match you with the ideal Cochlear Buddy for you. 1. What do you like to do in your spare time? 2. Are you at school/working/retired? 3. What is your preferred contact method?

By submitting this form, I agree that Cochlear may:

Use the personal information (including sensitive information) provided above for the purpose of running the Cochlear Buddies program
Use the personal and health information provided for marketing related purposes, including providing me with information about Cochlear products and services that may be of interest via phone, post and electronically. (I may opt-out at any time)
Share my personal and sensitive information with a Cochlear Buddy so they can contact me to discuss their personal hearing journey
Connect me with a different Cochlear Buddy if the Cochlear Buddy I am trying to connect with is unavailable
Share any correspondence between a Cochlear Buddy and I within Cochlear

I agree to Cochlear processing the personal and health information above for marketing purposes and in accordance with Cochlear’s Privacy Notice