Hearing Aid Bill of Sale/Purchase Agreement

This is a patient/practice document. This document, specifically created to meet the legal requirements of each state, includes information such as make and model of aid, serial numbers, condition of aid, warranties, terms of purchase, patient and audiologist signature, dates, and costs. This form can be created to conform to either a bundled or unbundled delivery model. If interested in both versions, please contact ADA Headquarters. Order includes Bill of Sale for one state, bundled or unbundled. This form is provided in Word format, and will be delivered in 5-10 business days upon purchase.