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Hearing Instruments
Hearing Healthcare Professional: _________________________
_____________________________________________________
Telephone: ___________________________________________
Model:_______________________________________________
Serial Number: ________________________________________
Replacement Batteries:
Size 675
Warranty: ____________________________________________
Program 1 is the program for: ____________________________
Program 2 is the program for: ___________________________
Program 3 is the program for: ___________________________
Program 4 is the program for: ___________________________
Date of Purchase:______________________________________
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