Get Custom Ear Piece Order Form - Phonak

Filling out the Custom Ear Piece Order Form - Phonak online can streamline the process of ordering personalized ear pieces. This guide provides clear instructions to assist you in completing the form accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to retrieve the form and open it in your editor of choice.
2. Complete the customer information section by providing your last name, first name, address, city, state, zip code, email, and phone number. Be sure to include the age and gender if applicable.
3. Fill in the patient information, noting the necessary account numbers and audiogram details. Ensure that you enter the purchase order number and any relevant audiometric data.
4. In the HI warranty section, select your desired warranty period and any applicable rush options, including 24-hour service.
5. Proceed to the hearing instrument selection. Indicate if you wish to purchase a hearing instrument by checking the appropriate boxes and noting the quantity required.
6. Continue to the custom ear piece selection, where you will denote the side and power level of the ear piece. Choose a shell style and indicate the receiver length as needed.
7. Select ear piece options, including cShell and SlimTip colors from the provided choices. Be sure to specify any additional customizations you require.
8. Complete the accessories section if you need additional items like a PilotOne or ComPilot. Indicate any special instructions or preferences at the end of the form.
9. After filling out all sections, review for accuracy, save your changes, and download, print, or share the completed form as required.

Start completing your documents online now!