Order Info

null

Medical Clearance



I have been advised by Premier Medical that the Food and Drug Administration (FDA) has determined that my best interest would be served if I had
a medical evaluation by a licensed physician (preferably a physician who specializes in diseases of the ear) before purchasing a hearing aid. (See FDA info on home page)

I am 18 years of age or older and I do not wish to have a medical examination before purchasing a hearing aid from Premier Medical.

Note! F.D.A. regulations require either faxed medical clearance or the statement indicating you want to buy the aid without seeing a Doctor be included with your order for us to sell it to you.

Signature: ____________________________________

Date: _________________________________________

(Must be printed and Fax/Send to us before order is dispatched)

** Not Required for International **