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CORE Custom Order Form Wireless/Connectivity Custom Order Form Date: Contact: Billing Information: Acct #: 1. Same as Shipping: Address: Patient First Name PO #: Shipping Information: Patient Last
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How to fill out phonak custom order form

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How to fill out the Phonak custom order form:

01
Start by gathering all the necessary information. The order form will typically require details about the patient, such as their name, contact information, and date of birth.
02
Next, provide the necessary information about the hearing healthcare professional. This can include their name, clinic information, and other relevant details.
03
Fill in the information related to the specific hearing aids being ordered. This can include the model, style, and any additional features or accessories that the patient may require.
04
Indicate the desired color and any specific preferences for the hearing aids.
05
Provide information about any customizations or modifications that may be needed. This can include details about the ear mold or any other special requirements.
06
Fill in the payment details section, including the method of payment and any billing information required.
07
Review the form for accuracy and completeness before submitting it to ensure there are no errors or omissions.

Who needs Phonak custom order form?

01
Individuals who require custom-fit hearing aids may need to fill out the Phonak custom order form.
02
People who have specific hearing needs or preferences that cannot be met with standard hearing aids may require a custom order.
03
Hearing healthcare professionals use the custom order form to facilitate the ordering process and ensure that their patients' unique needs are met.
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The Phonak custom order form is a document used to place custom orders for Phonak hearing aids.
Audiologists, hearing care professionals, or individuals ordering custom Phonak hearing aids are required to file the form.
The form must be completed with the necessary details such as patient information, hearing aid specifications, and payment information.
The purpose of the Phonak custom order form is to facilitate the ordering process for custom Phonak hearing aids.
Patient details, hearing aid specifications, and payment information must be reported on the form.
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