Get Custom Order Bformb - Beltone Hearing Centre Edmonton - Home

Filling out the Custom Order Bformb is an essential step in obtaining the necessary hearing aids and accessories from Beltone Hearing Centre Edmonton. This guide will provide you with a clear and simple process for completing the form online, ensuring that all necessary information is accurately recorded.

Follow the steps to successfully complete the Custom Order Bformb online.

1. Press the ‘Get Form’ button to access the Custom Order Bformb and open it for editing.
2. Begin by entering the patient's information in the 'Patient Information' section. Provide the patient's first and last name, street address, city, province, phone number, and birth date. Identify whether the user is a new or prior Beltone user.
3. Input audiogram data under the 'Audiogram Data Hearing Threshold Level in dB HL' section. Record the hearing thresholds for both the right and left ears across the specified frequency levels.
4. Complete the 'Vent Modification' section by selecting options applicable to the vent requirements for both the right and left ears, considering any special specifications mentioned.
5. In the 'Patient Controls' section, indicate preferences regarding features like telecoil, remote control options, and any program button selections based on your needs.
6. Choose 'Shell Colour' and 'Faceplate Colour' based on user preferences and available options. Review the color selections to ensure they meet the aesthetic requirements.
7. Navigate to the 'Impression Information' section and indicate the impression type and ear consistency. Provide additional detail for canal length and any specific model requests.
8. Review the warranty options in the form and select the desired package that best fits the user's needs.
9. If applicable, complete the special instructions section to communicate any specific customization requests.
10. Finally, review all entered information for accuracy before saving changes. You may then download the form, print it, or share it as necessary.

Complete your Custom Order Bformb online now for a seamless hearing aid ordering experience.