Hearing service and device offer record
For planned purchasing conversations. Sudden hearing loss needs urgent assessment, not shopping. This sheet does not determine eligibility or rank devices.
Need and device category
Listening task(s) to discuss: ____ Assessment completed / pending: ____ Exact device(s) and category: ____ One or both ears / one or two devices: ____
What the quote includes
Device components: ____ Fitting / programming / adjustments: ____ Rehabilitation / training where proposed: ____ Phone/app/account requirements: ____ Consumables and accessories: ____ Follow-up service and period: ____ Unknown items: ____
Returns and repair
Return policy exists / absent / unknown: ____ Deadline starts on: ____ Fees and condition requirements: ____ Warranty provider, period and exclusions: ____ Repair route and costs: ____ Temporary replacement arrangements: ____
Coverage and responsibility
Full price or estimated patient share? ____ Payer/provider confirmation and date: ____ Required authorization / documents / next owner: ____ No declared saving until product, service scope and payment basis match.
Original organizational template, not a medical test. All free decision records · Related reading paths