Transcription of Phonak Service Form - phonakpro.com
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Phonak Service Form - phonakpro.com
Phonak Service Form Step 1: Customer Information Step 2: Device Information Ship To Account Number: Date: Device Model/Serial Number: Address: n Receiver (must accompany device) size/side (0 3, L/R): City: State: Zip: n SlimTube (if included) size/side included (00 3, L/R): Bill To Account Number: n Ear hook color: Address: Custom Ear Piece Model/Serial Number: City: State: Zip: n Hearing instrument is not included in this repair Patient Name: Patient is under 21 years of age n (Check box if yes) Complete Step 3 Step 3: RogerDirect Installation Information Third Party Patient Number: Is RogerDirect installed in the paradise /Marvel device? n Yes n No Purchase Order Number: If yes, please select the install method: Contact Name: n Roger X (02) Pediatric Phone Number: n Roger iN Microphone or Roger X (03) Home/Work/University Phone number required for shipping directly to patient or school. We're unable to ship to a Box. Additional charge for shipping directly to the patient.
If the patient’s settings cannot be restored we will ship back to the sender. Phonak U.S. | 750 North Commons Drive | Aurora, IL 60504 | Phone 800-777-7333 | Fax 630-393-9858 ... Fax 630-393-9858 n Step 3: RogerDirect™ Installation Information Is RogerDirect installed in the Paradise/Marvel device? n Yes n No If yes, please select the ...
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