Get Pico Rite Earmold Styles Bernafon, Llc

This guide offers step-by-step instructions on how to effectively fill out the PICO RITE EARMOLD STYLES form provided by Bernafon, LLC. Ensure you have all necessary information ready for a smooth completion of the online form.

Follow the steps to complete your form accurately.

1. Begin by pressing the ‘Get Form’ button to access the PICO RITE EARMOLD STYLES form in an online format.
2. Fill in the member information section with the required details, including the order number and the user's last name and first name.
3. In the audiometric information section, provide details such as today's date and the audiometric data (Hz levels for both right and left ears: AC and BC).
4. Check the box corresponding to the PICO RITE speaker selection that fits your needs among the given options (60-Speaker, 85-Speaker, or 100-Speaker). Ensure you select the receiver length for the 100-Speaker if applicable.
5. Choose your desired earmold style from the list provided. Indicate the total quantity required and specify the material for each earmold.
6. Select the appropriate venting options based on user preference and fit, marking left (L) and right (R) as needed for each style.
7. Fill out any additional options if required, such as receiver tubing colors or printing specifications.
8. If applicable, provide any details for existing instruments, including model and serial numbers.
9. Complete the shipping information section, entering the name of the Hearing Care Professional, their address, and contact details.
10. Once all sections are filled out, review the form for accuracy. Save changes if prompted, then download, print, or share the completed form as required.

Start filling out your PICO RITE EARMOLD STYLES form online today!