Get Phonak Order Forms

The Phonak Order Forms are essential for ordering custom hearing instruments. This guide provides step-by-step instructions to help you fill out the form accurately online, ensuring that all necessary details are captured.

Follow the steps to complete your Phonak Order Form online.

1. Press ‘Get Form’ button to access the Phonak Order Forms. This action will open the form in your preferred editor.
2. Begin by entering the Order Details. Fill in the account number, patient's last name, first name, hearing clinic, delivery address, and the serial number of any previous Phonak custom product if applicable. Provide the contact name, phone number, email address, date ordered, and the date required.
3. Review the HI Warranty / Return Policy section. Confirm the standard 3-year warranty, or if desired, select the extra 1-year warranty at an additional cost of $140 per device.
4. Choose the Performance Level. Specify whether you're selecting the Virto B90 - Titanium or Virto B70 - Titanium, noting that VIP option is not available.
5. Fill in the AOV Details. Indicate the experience level of the user (first-time or experienced), as well as the age and audiogram data for both the left and right ears. Audiogram data is mandatory for the AOV.
6. Select from the Product Options. Choose the size preference and power level. Indicate if you require a wax system, select vent type, cosmetics, and input options. Include any special instructions or requests that you may have.
7. Note any Special Instructions you may have regarding the order to provide additional context to the fulfillment team.
8. Choose your complimentary cleaning kit from the options provided. This could include the C&C ITE Cleaning Kit or the D-Dry Electronic Dry Aid Kit.
9. Once all sections are completed, you can save the changes, download the form for your records, print it, or share it as needed.

Start completing your Phonak Order Form online today.