Following FDA regulations,
we ask you to agree to one of the two statements below before purchasing your
hearing aids.
Choose from one of these two statements
1) I have been given a hearing evaluation by a licensed physician
and have received a recommendation for a hearing aid. (Please
send recommendation to HearPod at customerservice@myhearpod.com,
or fax to 800 409-5128.)
2) I am hereby advised by HearPod that the Food and Drug Administration
has determined that my health interest would best be served if
i had a medical evaluation by a licensed physician prior to being
fit with hearing device(s).
I understand the FDA regulation and state that I am at least 18 years of age and believe,
in my own judgement, that I am qualified as a candidate for hearing
aids. (In accordance with FDA regulations, your choice will be
kept on file by HearPod for three years from the date of purchase.)
*required
Please enter your full name below, acknowledging your understanding
and agreement to the above:
*required
Please enter your full name below:
*required
Thank you! Please continue.
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