Get Widex Custom Order Form

The Widex Custom Order Form is essential for users seeking customized hearing aids and accessories. This guide will help you navigate through the form efficiently, ensuring all necessary information is accurately provided.

Follow the steps to complete the Widex Custom Order Form online.

1. Press the ‘Get Form’ button to access the Widex Custom Order Form and open it in your document editor.
2. Complete the service priority section by selecting your preferred shipping option: Next Day or Standard. Provide your Purchase Order number, billing information, and the date.
3. Fill in the shipping details, including the contact name and, if applicable, Third Party information. Indicate your client or claim number in the respective field.
4. Enter patient information such as the patient's full name, date of birth, ear texture, and impression type. Add the previous model if relevant.
5. For air conduction thresholds, input the relevant values for each frequency. If modifications are needed due to audiogram permissions, indicate accordingly.
6. Select the hearing aid and accessories from the options provided, referencing styles, series, and models. Ensure to check the desired features like program buttons and volume control.
7. Choose the color for the hearing aids as well as any additional accessories that may be required.
8. Review and select hearing aid options such as canal lock, soft coat, DEX options, and vent sizes, specifying if an impression is necessary.
9. Indicate the supplies and order forms needed. Choose from the listed options for no-charge selections if applicable.
10. Once all fields are completed, you may save your changes, download, print, or share the form as required.

Begin your Widex Custom Order Form online today for a seamless experience.