Get Custom Earpieces Order Form - Phonak

Filling out the Custom EarPieces Order Form - Phonak online is a straightforward process. This guide will provide you with step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to fill out the Custom EarPieces Order Form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by providing patient information in the designated fields. This includes the first name, last name, age, gender, city, state, and zip code. Ensure all required fields are completed carefully to avoid any delays.
3. In the customer information section, fill in your shipping and billing details, including any account numbers and purchase order numbers if applicable. This section helps ensure that the order is processed correctly.
4. Indicate the audiogram information if required. Fill in the necessary frequencies for both the left and right ears. This is crucial for accurate customization of the ear pieces.
5. Select your warranty preference for either two, three, or four years. Make sure to mark your choice clearly.
6. Next, proceed to the custom ear piece selection section for either RIC or BTE. Choose the appropriate features such as side (left or right), shell styles, instrument type, and technology level. Additionally, specify the color choice from the options provided.
7. Fill out the accessory selection. Choose any additional components you may want to include, such as ComPilot or iCom, and indicate your preferences for shell options and wax prevention features.
8. If you have any special instructions, indicate so in the respective section and provide details as needed.
9. Review all information entered to ensure accuracy. Once confirmed, save changes, download, print, or share the form as required.

Complete your Custom EarPieces Order Form online today to ensure you receive your custom solutions efficiently.