Date Order : *   Date Required : *
PO/Indent No :   Hearing Clinic : *
Client Name:  *   Client ID :
Age :   
Ordered By: *   Contact Phone:  *
Contact Email ID:  *
 
Binoural Order    Monoural Order
 
 
Step 1. Enter the Audiogram - Air Conduction only. (Required for AOV)
Ear 250Hz 500Hz 750Hz 1kHz 2kHz 3kHz 4kHz 6kHz 8kHz  
Right dBHL
Left dBHL
 
Step 2. Choose your Marvel Instrument Models (Style, Product Family, Options)
 
2.a Choose the Style you like to Order
 
RIC 
 
2.b Choose which Product Family you want to order
 
Audeo M    Audeo M-R 
RIC R L
RIC R L
RIC R L
Audeo M90
Audeo M90 - R
Audeo M70
Audeo M70 - R
Audeo M50
Audeo M50 - R
Audeo M30
Audeo M30 - R
Audio M90 - RT
Audio M70 - RT
Audio M50 - RT
Audio M30 - RT
2.c Please choose the below options
  Options Right Ear Left Ear
  Power Level
  Standard Tube Options
  Ear mould
  Vent
  Slim Tube Options
  Dome Sizes
  Tube Length
  Housing Color
  Options Right Ear Left Ear
  Shell
  Power Level
  Omni / Directional
  Wireless / Non-wireless
  Venting
  Venting
  Wax Management - SmartGuard recommended (select 2nd choice if cancel deemed too small to have SmartGuard)
  Wax Management
  Handling Option
  Options Right Ear Left Ear
  Battery Sizes
Note:

1) Options for Virto B Titanium nano:
   With Mini Control
   Without Mini Control

2) Options for Virto B Titanium Size 10A CIC:
   Standarad Configuration: Program Button(PB) + Telecoil(TC)
   Program Button(PB)
   Telecoil(TC)

  Titanium Nano
  Virto B Titanium Nano
  Virto B Titanium Size 10A CIC
2.d If you have chosen Custom Products please choose the below options
  Options Right Ear Left Ear
  Shell
  Power Level ( 2cc Gain/MPO)
  Venting
  Venting
  Wax Management - SmartGuard recommended (Select 2nd choice if canal deemed too small to have SmartGuard)
  Wax Management
  Handling Option
2.d If you have chosen RIC Products please choose the below options
  Options Right Ear Left Ear
  Receiver
  Earpiece
  Venting
  Receiver Wire length
  Housing Color
 
 
Step 3. Customer Preference Service Step 3. Customer Preference Service
 
Please change options for better techinical performance.
In case of space constraint, please give size priority.
In case of space constraint, please give options priority.
Please contact me for approval of any changes.
 
Step 4. Pediatric Kit Step 4. Pediatric Kit
 
Do you require a pediatric kit?  Yes  No
 
Step 5. Special Instruction Step 5. Special Instruction
 
 
Enter Security Code
 
Security Image
Can't read the image? click here to refresh.