Introduction: Understanding patient preferences is critical to improving hearing aid uptake, adherence, and long-term outcomes. The rapid expansion of over-the-counter (OTC) hearing aids and alternative service delivery models has introduced greater choice but also increased complexity in decision-making. While OTC devices offer potential advantages such as reduced cost and increased accessibility, it remains unclear how adults with hearing difficulties prioritize these benefits relative to professional support, device performance, and reliability. This study aimed to examine patient-reported preferences for hearing aid features and service delivery models, and to explore how these preferences align with demographic and hearing-related characteristics. Methods: A cross-sectional survey was conducted within an ongoing four-arm randomized clinical trial evaluating service delivery models for hearing care. A total of 114 adults with self-reported hearing difficulties completed a structured questionnaire at baseline. The survey captured demographic variables, hearing-related characteristics, and preferences across two domains: (1) hearing aid features (e.g., performance in noise, comfort, reliability, cost), and (2) service delivery models (e.g., professionally fitted prescription devices, OTC devices with remote or in-person support). Responses were analyzed using descriptive statistics to identify patterns in patient priorities. Results: Participants had a mean age of 66 years; 73% were female, 77% had a university-level education, and 53% were retired. Approximately 39% reported annual household incomes between $50,000 and $99,999, and 28% lived alone. Across hearing aid features, the highest-rated 1 IHCON 2026 attributes were the ability to communicate effectively in noisy environments, physical comfort, and device reliability. Cost was an important consideration, but was not the primary driver of decision-making. Regarding service delivery, participants expressed a strong preference for prescription hearing aids fitted by hearing care professionals. In contrast, OTC models supported exclusively through remote or online assistance were least preferred. Many participants reported discomfort with purchasing hearing aids without a prior hearing evaluation and emphasized the importance of professional guidance during selection and fitting. Conclusions: Adults with hearing difficulties prioritize functional performance in complex listening environments, comfort, and reliability, alongside access to professional expertise. Despite increased availability of OTC hearing aids and remote care pathways, traditional clinician-supported models remain highly valued. These findings highlight the need to integrate patient preferences into the design of hearing technologies and service delivery frameworks, ensuring that emerging models balance accessibility with adequate professional support to optimize outcomes.