Owner Information
MODEL: _______________________________________
SERIAL NUMBERS:
LEFT: __________________________________
RIGHT: _________________________________
PURCHASE DATE: _______________________________
BATTERY SIZE: _________________________________
MEMORY SET-UP:
MEMORY A: ____________________________________
MEMORY B: ____________________________________
MEMORY C: ____________________________________
MEMORY D: ____________________________________
TYPE OF HEARING AID: _________________________
_______________________________________________
SIZE OF HEARING AID: __________________________
_______________________________________________
ORIGINAL WARRANTY EXPIRES: __________________
_______________________________________________
HEARING HEALTH CARE PROVIDER: ______________
_______________________________________________
