Date Order : *   Date Required : *
Delivery Address: *   Hearing Clinic : *
Client Name:  *   Patient reference:
Contact Email: *   Contact Phone:  *
 
 
Step 1. Audiogram
Hz 250 500 1000 2000 4000
LEFT AC (dB HL) dBHL
RIGHT AC (dB HL) dBHL
 
Step 2. Choose hearing instrument
 
Naida M-SP 
 
Model R L
Naida M90-SP
Naida M70-SP
Naida M50-SP
Naida M30-SP
 
Step 3. Choose your Sound Delivery System
 
  Tone Hook with Earmould
  Ear mould
  Vent
  SlimTube with domes or SlimTip
  Acoustic coupling
  Tube Length
  Housing Color
 
Step 4. Choose accessories
 
TV Connector
076-3006-06
RemoteControl
076-0065-P5
PartnerMicâ„¢
076-4001-P510
 
Step 5. Customer Preference Service
 
In case of space constraint, please give Performance/functions priority.
Please contact me for approval of any changes.
 
Step 6. Special Instruction
 
 
Enter Security Code
 
Security Image
Can't read the image? click here to refresh.