Get Oticon Earmold Order Form

The Oticon Earmold Order Form is a crucial document for ensuring you receive the correct hearing instrument and earpiece fit. This guide provides a detailed overview of how to complete the form accurately and effectively online, catering to the needs of users with varying levels of experience.

Follow the steps to complete your earmold order form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred digital format.
2. Start filling in the patient information section. Enter the date the order was placed, followed by the patient's name. Ensure that you do not write in the designated spaces for manufacturer use.
3. Provide clinician contact details, including a purchase order number and two account numbers: one for billing and one for shipping.
4. List the name and address of the shipping recipient, ensuring all details are accurate for prompt delivery.
5. Indicate your choice of RITE or BTE style by checking box A or B. If you select box A, specify the make and model of the earpiece you will be fitting. If you choose box B, indicate the earpiece and instrument(s) you wish to order and specify the left (L) and right (R) sides.
6. Select a color for the earmold from the options provided, referencing the next page if needed.
7. Choose the desired RITE or BTE options, including material type (acrylic or silicone) and any specific options like canal locks or vent sizes as applicable.
8. For additional options, you may select any relevant streamer or connect line products required, ensuring compatibility information is noted.
9. Include any special instructions relevant to your order in the designated section.
10. Once all sections have been completed, save your changes, and choose to download, print, or share the form as needed.

Complete your Oticon Earmold Order Form online today for a streamlined experience.