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 review our Privacy
Policy. (Print a copy, if you wish.)
*required
Please enter your full name below:
*required
Thank you! Please continue.
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