Follow the steps to fill out the Signia rebate form

1. Click 'Get Form' button to obtain the form and open it for completion.
2. In the Patient Information section, fill in your personal details. Ensure that the information is accurate and complete, including your name, address, city, state, zip code, phone number, and email.
3. Provide the serial numbers for each hearing aid. You will need to record the left and right hearing aid serial numbers in the spaces provided. If you are unsure, refer to your User Manual or ask your hearing care provider for assistance.
4. Enter the name and address of your hearing care provider in the designated fields. It is important that this information is correct for the rebate process.
5. Indicate your relationship to the patient by circling the appropriate option: Patient/Hearing Aid Wearer, Hearing Care Professional, Care Taker, or Other, and specify if necessary.
6. Record the date of purchase within the given space to validate your rebate eligibility. Make sure the date falls between December 1st, 2016 and January 31st, 2017.
7. Specify the product name and performance level of the hearing aids you purchased by marking either '7' or '5' in the provided checkboxes.
8. Attach a copy of the receipt for your purchase. This documentation is crucial for the processing of your rebate request.
9. Once you have completed all sections of the form, you can choose to save changes, download, print, or share the completed form as required.
10. Finally, mail or fax this completed form along with the copy of your receipt to the appropriate address or fax number provided.

Complete your Signia rebate form online today to enjoy your savings!