Hearing Aid Adjustment & Repair Form

You can now post your Hearing aid/cochlear/baha devices to our clinics for adjustments – Simply complete this form and mail your devices into us. Please ensure you provide a detailed description of any issues or adjustments that need to be done.

Your Details
Name*
First Last
Return Mailing Address
Return Mailing Address*
Street Address Address Line 2 City State Post Code
Mobile Phone*
Mobile Phone
Additional Supplies Required
Video Chat Function Used: e.g. Facetime, Skype, messenger or can you download a video chat application
Email*
Email Address
Usual clinic location*
Usual clinic location
Additional Supplies Required
Hearing Aid's
Detailed Issue Description*
Detailed Issue Description
Additional Supplies Required
Please list any accompanying supplies you require
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Your Details

Return Mailing Address

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