Hearing Aid Repair

Hearing Aid Repair Request Form

Type or print legibly

Hearing Aid Users First Name

 

Hearing Aid Users Last Name

 

Date of Birth

 

Street Address (where to return hearing aid)

 

City

 

State

 

Email

 

Sender information if different from the hearing aid user

 

Hearing Aid brands that Hearing Aid Services PLLC will accept include Phonak, Oticon, Unitron, Widex, ReSound, Signia, and Starkey. Other hearing aid brands will be returned to the sender without repair and the sender will be charged for shipping. Cannot repair hearing aids bought from Costco.

Hearing Aid Make

 

Hearing Aid Model

 

Right Serial Number

 

Left Serial Number

 

Hearing Aid Condition (dead, high battery drain, cracked, distorted, intermittent, weak, other)

 

Hearing Care Clinic Information

 

 

Warranty information (if known)

 

Payment must be received before hearing aid/aids are repaired. To pay for the repair select the repair that applies to your hearing aid/aids on the shop page, send cash or check. If selecting the appropriate repair product you can checkout using the websites secure payment. If sending check or cash include this with your hearing aid/aids when sending them to Hearing Aid Services PLLC for repair. Make checks out to Hearing Aid Services PLLC. If you would like a quote before sending your hearing aid/aids to Hearing Aid Services PLLC you can request a quote by emailing this form to hearingaidservicespllc@gmail.com.

Be specific about the condition of your hearing aid/aids.

A quote will not be provided without serial number/s as this information is used to determine the age and warranty status of your hearing aid/aids.

Read and Sign the bottom of the form. Send this form with your hearing aid/aids for repair.

Pricing for hearing aid repairs

Under warranty hearing aid repair:

$50.00 per hearing aid

$100.00 per pair of hearing aids

This fee is for processing shipping and handling it does not include the repair itself as that should be covered under the hearing aid warranty.

Hearing aid repair for hearing aids under 5 years of age with discontinued warranty:

$300.00 per hearing aid

$600.00 per pair of hearing aids

This fee includes repair of hearing aids, 6-month repair warranty, shipping, processing and handling.

Hearing aids over 5 years of age:

$400.00 per hearing aid

$800.00 per pair of hearing aids

Most manufacturers will discontinue hearing aid models after 8-9 years of age. This does include the parts to repair these models. If your hearing aid/aids are around 8-9 years of age or older they may not be able to be repaired.

If the hearing aid/aids can be repaired this fee includes repair of hearing aids, 6-month repair warranty, shipping, processing and handling.

Make sure to package your hearing aid/aids securely in a padded box or envelope. Print and package this form with your hearing aids. If this form is not included hearing aids will be returned to the sender and the sender will be charged for shipping.

Send your hearing aid for repair to:

Hearing Aid Services PLLC

PO BOX 489,

Nine Mile Falls, WA 99026

Sign below stating that you understand the information given to you and that the form is filled out to the best of your ability.

 

 

Signature                                                                       Date