Hearing Systems, Inc.

Revised 5/29/2007

HEARING AID INFORMATION

If based on the results of your audiologic evaluation, it has been determined that you are a candidate for amplification. The subsequent steps involved in the selection and fitting of an appropriate hearing aid, follow-up services, and maintenance services are outlined below.

Step 1: THE HEARING AID CONSULTATION

The purpose of this evaluation is to select a specific hearing aid for your use. The audiologist will demonstrate available types of aids, and discuss your preference. The pros and cons of each type of fitting will be discussed with you at this time. An impression of your ear will be taken and sent to the appropriate manufacturer or ear mold lab.

Step 2: THE HEARING AID FITTING

When the hearing aid arrives, we will schedule an appointment to fit the hearing aid and instruct you in the use and care of the hearing aid. Payment in full is required at this time. Any contractual arrangements must be made prior to this time.

You are entitled to a 30, 45 or a 60 day trial period when purchasing an aid. This trial period begins the day the aid is dispensed to you. The trial period will allow you to use the aid in your home environment. If problems arise during this period you should contact the audiologist, who will be able to make changes in your aid to help overcome these problems. Regular contact with the audiologist during this trial period will allow you to make the most of this trial period.

FULL Payment is required when the hearing aid is dispensed. Other arrangements must be made prior to this. Anytime during the 30 to 60 day trial period, you may return the aid if you are not satisfied. All moneys will be refunded except for $100.00 for the conventional type amplification or $200.00 for computer programmable/Digital aids, which covers testing and administrative costs. Ear mold fees are non-refundable.

Step 3: THE HEARING AID FOLLOW UP

Within the 30-60 day trial period, YOU will be responsible to schedule and keep an appointment for a follow-up visit at NO-CHARGE. You will be tested / evaluated with your aid to determine if it is supplying adequate aided benefit. More than one (1) and up to 3 follow up appointment(s) may be required to adjust and tune your hearing aid. Please call if you have any questions or if you need assistance during this time.

APPROXIMATE COSTS INVOLVED IN OUR PROGRAM

1. Complete Audiometric Evaluation: $80.00**, (Includes Air and Bone Conduction, Speech Discrimination, Most Comfortable Levels, Uncomfortable Loudness Levels, Typanometry.)

2. Hearing aid consultation: $80.00**: (Includes computer analysis of hearing aid, Aided Performance Audio, any adjustments and changes to improve the performance of your present aid.)

** These fees are waived if new hearing aid is purchased through our office.

3. Approximate Hearing aid costs: Hearing aid prices range from $600.00 to $2800.00 depending on model, style and features requested.

Basic Model terminology/acronyms: ITC - In The Canal

ITE – In The Ear

BTE – Behind The Ear

CIC – Completely In the Canal

RITC – Receiver In The Canal

We sell all models of hearing aids from Oticon, Unitron, Phonak, Widex, Siemens and Starkey among others.

Most all aids come with a ONE YEAR Warranty and one year of insurance (Loss/Damage), some have two and even 3 year warranties. All aids are eligible for extended warranties, please ask for specific quote. Behind the ear aids require an ear mold ($55.00/each). Special hearing aid arrangements such as body aids, CROS, bicros, eyeglass etc. will be quoted at the time of the hearing aid consultation.

Discount for Purchase of Two Aids. {may not apply to Digital / Programmables}

Binaural (2) Hearing Aids - Double the cost, then subtract $100.00.

THE HEARING AID PRICE INCLUDES:

¨ The hearing aid

¨ Any visits related to the use of the hearing aid during the Trial period following the fitting.

¨ The ear mold impression for in the ear hearing aids only.

¨ Initial supply of batteries.

¨ Complete service during the warranty period offered by the manufacturer. Service after the warranty period is over will be billed at the time of service rendered. Some manufacturers will offer additional warranty which can be purchased at the discretion of the user. There is an additional charge for this warranty. Insurance against loss/theft of the aid is available at an additional charge. We recommend this to protect your investment.

¨ Programming of Digital/programmable aids is included in the price of the hearing aid for a period of the warranty period of the hearing aid , a maximum of three hours of follow-up visits. After that reprogramming will be billed at $80.00 (1hr) and $40.00 per half hour as needed. This policy takes effect after the trial period ends.

FOLLOW-UP MAINTENANCE/REPAIRS Our available services are as follows:

REPAIRS: We will be happy to send your aids in to the manufacture for repair when they are broken. You will be without your aid for approximately 7 to 10 working days if it requires repair at the factory. Repair costs will be quoted on a flat fee basis with a 12-month warranty. In house repairs will take a couple of days at most.

BATTERIES: Batteries, from $4.50 for a 4 pack package of Rayovac Premium Ultra Zinc-Air and up, can be mailed to your home when requested (there is no shipping charge). For qualified customers an invoice can be included, and payment can be returned to our office. Batteries may also be picked up at the office during regular office hours. Discounts for quantities are available. Purchasers of high end hearing aids are eligible for significant discounts on batteries.

MISCELLANEOUS: Minor problems, such as ear mold tubing replacement and some battery doors, will be taken care of in the office. For ear mold remakes, impressions will be taken in the office at a scheduled appointment and then sent to an ear mold laboratory for completion.

LOANER HEARING AIDS:

During the time any behind the ear aid is in for repair you may request a loaner aid if one is available. Loaners for patients with in the ear aids will not be available due to a lack of custom ear molds for these patients, however every attempt will be made to fit you with a stock temporary ear mold. We suggest In The Ear users purchase a custom ear mold for such emergencies. Because of short supply of loaners we encourage all patients to retain their own “old” hearing aids for this purpose as the loaner we provide will NOT have the same features or ability as ones current aid. Monaural hearing aid wearers will also have preference for loaners as they will not have the luxury of a working secondary aid. We do not supply loaners to clients who are actively in the process of obtaining new hearing aids, that will ultimately be addressed by the trial period.

Please feel free to call and discuss any questions concerning the hearing aid you may have with the audiologist.

ANY COMPLAINTS MAY BE FILED IN WRITING TO:

State Board of Examiners for Speech Pathology and Audiology

1100 West 49th Street

Austin, Texas 78756

(512) 834-6627

D. Max McCarthy, M.A., CCC-A

Audiologist/President

We Carry a Full Line of Assistive Devices for Consumer, Corporate and Educational Use. Inquire about our catalog !!!!