Get Holiday Loaner Request Form

Completing the Holiday Loaner Request Form online is a straightforward process designed to ensure you have the necessary equipment for your holiday. This guide will walk you through each section of the form to ensure you provide all required information accurately.

Follow the steps to complete your Holiday Loaner Request Form online.

1. Press the ‘Get Form’ button to access the Holiday Loaner Request Form and open it in your preferred editing tool.
2. In the Customer Information section, enter the name of the MED-EL user in the designated field, followed by the user’s email address, mailing address, and postal code.
3. Provide a daytime telephone number where you can be reached. If applicable, fill in the name of a parent or guardian.
4. Specify the dates of your holiday by entering the start and end dates in the fields provided.
5. Select your clinic from the drop-down list and check the box if you are requesting a bilateral processor.
6. Indicate the type of processor you are requesting by selecting from the options: OPUS 2, RONDO, TEMPO+, or DUET 2.
7. Read and understand the terms and conditions regarding the holiday loaner. Ensure you note the cost and liability information provided.
8. Print your name, enter the date, and provide a signature in the designated fields to confirm your agreement to the terms.
9. Choose your payment method by selecting either BACS or cheque and providing necessary details for the chosen option.
10. After completing the form, save your changes. You can then download, print, or share the form as needed.

Complete your Holiday Loaner Request Form online today to ensure a smooth and enjoyable holiday!