Signature RIC / DEAFMETAL®

Signature RIC Earmolds & Deafmetal^®

Please read before ordering

Order Number
Account Number*

Step 1: Patient, Audiologist, and Impression Details
Date
Same Day Lab Process & Overnight Shipping
All "same day" lab requests must be received by 10:30 AM. Otherwise, order will be shipped on next business day.

Additional charges of $16/ear Lab Fee and $30 Overnight Shipping apply.
- Yes
Business Name*
Promo Code
PO# (If applicable)
Medicare/Medicaid# (If applicable)
Patient Name*
First Last
Audiologist Name*
Prefix First Last
Audiologist Email*
Audiologist Phone (USA)
Audiologist Phone (International)
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Audiologist Phone
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Audiologist Phone: International
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Impressions (R/L)
If you are configuring earmolds differently for each ear, please complete two online forms, one for each ear.
Use impressions from previous order #
Return Impressions
Is this a REMAKE?*
REMAKES: To order an earmold remake, you must upload photos of the earmolds in question.
Reason for Remake.
Are you mailing your impressions?*
- YES
- NO
Are you uploading your impression scans?
- YES
What type of scanner did you use?*
If you are submitting LANTOS ear scans for this order, please upload scans to the LANTOS Cloud.
Otoscan® Package ID Number
Upload Impression Scans
Drop files here or

Accepted file types: zip, stl, asc, Max. file size: 128 MB.
Impression Quality Standard
It is important to submit a complete and accurate impression. 1GB upload limit.
Upload LANTOS Scans
Drop files here or

Accepted file types: zip, stl, asc, Max. file size: 128 MB.
Impression Quality Standard
It is important to submit a complete and accurate impression. 1GB upload limit.
Upload In-Ear Scans - All Others
Drop files here or

Accepted file types: zip, stl, asc, hps, Max. file size: 128 MB.
Impression Quality Standard
It is important to submit a complete and accurate impression. 1GB upload limit.
Do you have any supporting documents or photos?
- YES
Upload Supporting Documents and Photos
Supported file-types:
.jpg .png .psd .doc .docx .pdf .xlsx .xls .tif .tiff .txt
Drop files here or

Accepted file types: jpg, png, psd, doc, docx, pdf, xlsx, xls, tif, tiff, Max. file size: 128 MB.
Special Instructions

Step 2: Shipping Details
Ship to Office or Patient?*
Main Office Name
Satellite Office Name
Patient Name
First Last
Ship to Main Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Ship to Satellite Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Ship to Patient
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Select Shipping Method
- Ground
- 2nd Day Air
- Next Day Air
- USPS Regular
- USPS Priority Mail
Use Your Own Account (optional)
- FedEx
- UPS
Your Account Number
Your Account Number
SAME-DAY LAB SHIPPING
You are submitting a "Same Day Lab" order.
This includes Overnight Shipping. [$28]
Special Mailing Instructions

Step 3: Signature RIC Earmolds
CUSTOM RIC PRICING
$42.00/per piece

• Select a Signature RIC earmold below.
• You MUST send receivers to Microsonic Inc. for Signature RIC products.
• Please use our HEARING AID EARMOLDS portal to order silicone RIC earmolds that do not require you to mail-in receivers.
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Signature RIC Styles
For RIC / SLIM (thin) Tube
- Signature CIC Style for
  RIC / Slim (thin)Tube
Signature CIC Style for RIC / Slim (thin)Tube
Signature BTE w/#13 Tubing, Slim (thin) Tube, or RIC
Standard Earmolds for RIC / Slim (thin) Tube
Standard Non-Occluding w/#13 Tubing & Slim (thin) Tubes
Other Custom Earmolds
#BF4 Lilly Features:
• Discreet CIC Style
• Venting (optional)
• RIC Only
• Recessed, position at 2nd bend
• Built-in Universal Connector for Receiver
• Right / Left Engraving is included
• Platinum Silicone Material
• Translucent with matte
• M60 Medical Grade Silicone
#CV5 CAVERN-LOK Description
• CIC Style, Occluding
• RIC or SLIM (Thin) TUBE
• Discreet Retention Lock (recommended)
• Right / Left Engraving is included
• Transparent Tint
• Silicone Material
#CV4 CAVERN Description
• CIC Style, Occluding
• RIC or SLIM (Thin) TUBE
• No Retention Lock
• Right / Left Engraving is included
• Transparent Tint
• Silicone Material
#CV05 OPEN CAVERN-LOK
• CIC Style, Open-Fit
• RIC or SLIM (thin) TUBE
• Discreet Retention Lock (recommended)
• Right / Left Engraving is included
• Transparent Tint
• Silicone Material
#CVO4 OPEN CAVERN
• CIC Style, Open-Fit
• RIC or SLIM (Thin) TUBE
• No Retention Lock
• Right / Left Engraving is included
• Transparent Tint
• Silicone Material
Ear Selection
Venting Options
#1A REGULAR W/TUBING
• Logo $6.00
• Special Shape $9.50

Special Notes:
• Occluding
• All Materials EXCEPT M2000
• Used with external receiver that snaps into earmold
#2 SKELETON
• Logo N/A
• Special Shape N/A

Special Notes:
• Occluding
• All Materials
• Open space in concha for appearance
#2A ¾ SKELETON
• Logo N/A
• Special Shape N/A

Special Notes:
• Occluding
• All Materials
• Recommended Skeleton style for dexterity issues
#2B ½ SKELETON
• Logo N/A
• Special Shape N/A

Special Notes:
• Occluding
• All Materials
• Recommended Skeleton style for dexterity issues
#OF2 OPEN-FIT SKELETON
• RIC & Slim (thin) Tube
• Logo N/A
• Special Shape N/A
#SL2 SLIM-FIT SKELETON
• RIC & Slim (thin) Tube
• Logo N/A
• Special Shape N/A
#3 SEMI-SKELETON
• Logo N/A
• Special Shape N/A

Special Notes: • Occluding
• All Materials
• Recommended for ears with flat concha rim to avoid
earmold sticking out from ear
#4 CANAL
• Logo N/A
• Special Shape N/A
#SL4 SLIM-FIT CANAL
• RIC & Slim (thin) Tube
• Logo N/A
• Special Shape N/A
#OF4 OPEN-FIT CANAL
• RIC & Slim (thin) Tube
• Logo N/A
• Special Shape N/A
#5 CANAL-LOK
• Logo N/A
• Special Shape N/A
#SL5 SLIM-FIT CANAL-LOK
• RIC & Slim (thin) Tube
• Logo N/A
• Special Shape N/A
#5A CANAL WITH HELIX
• Logo N/A
• Special Shape N/A
#5L CANAL WITH LONG LOK
• Logo N/A
• Special Shape N/A
#OF5 OPEN-FIT CANAL-LOK
• RIC & Slim (thin) Tube
• Logo N/A
• Special Shape N/A
#6 SHELL
• Logo $6.00
• Special Shape $9.50
#SL6 SLIM-FIT SHELL
• RIC & Slim (thin) Tube
• Logo $6.00
• Special Shape $9.50
#7 CANAL SHELL
• Logo N/A
• Special Shape N/A
#7A 3/4 SHELL
• Logo $6.00
• Special Shape $9.50
#OF7 OPEN-FIT CANAL SHELL
• RIC & Slim (thin) Tube
• Logo N/A
• Special Shape N/A
#SL7 SLIM-FIT CANAL SHEL
• RIC & Slim (thin) Tube
• Logo N/A
• Special Shape N/A
#17 CROS B
• Logo N/A
• Special Shape N/A
#21A ADV. DESIGN FREE FIELD
• S.A.V. included
• Logo N/A
• Special Shape N/A
#21B ADV. DESIGN FREE FIELD
• S.A.V. included
• Logo N/A
• Special Shape N/A
#21C ADV. DESIGN FREE FIELD
• S.A.V. included
• Logo N/A
• Special Shape N/A
#41A ADV. DESIGN FREE FIELD
• CANAL-LOK Style
• Logo N/A
• Special Shape N/A
#41B ADV. DESIGN FREE FIELD
• CANAL-LOK Style
• Logo N/A
• Special Shape N/A
#41C ADV. DESIGN FREE FIELD
• CANAL-LOK Style
• Logo N/A
• Special Shape N/A
#OF2 OPEN-FIT SKELETON
• Provides largest vent possible.
#SL2 SLIM-FIT SKELETON
• S.A.V. + $3.00
#OF4 OPEN-FIT CANAL
• Provides largest vent possible
• L/R Indicators included
• Acrylic + $1.00
#SL4 SLIM-FIT CANAL
• L/R Indicators included
• Acrylic + $1.00
• S.A.V. + $3.00
#SL5 SLIM-FIT CANAL-LOK
• S.A.V. + $3.00
#OF5 OPEN-FIT CANAL
• Provides largest vent possible.
#SL6 SLIM-FIT SHELL
• S.A.V. + $3.00
#OF7 OPEN-FIT | CANAL-SHELL
• Provides largest vent possible.
#SL7 SLIM-FIT CANAL-SHELL
• Provides largest vent possible.
#16 CROS A (no vent)
• Arylic Only - $42.00
• Completely open canal
• Designed for CROS & many IROS fittings
• Canal-Long Lok Style.
#17 CROS B (no vent)
• Designed for CROS and many IROS fittings
• Skeleton style
#18 CROS C (no vent)
• Recommended for attaching the offside
microphone or transmitter in a BTE CROS
or BICROS fitting
#18 CROS C (no vent)
• Seals entrance while leaving the entire canal unoccluded.
• Eliminates feedback
• SAV included
#21B ADV. DESIGN FREE FIELD
• Seals entrance while leaving the most canal unoccluded.
• Eliminates feedback
• SAV included
#21C ADV. DESIGN FREE FIELD
• A step reduction at the end of the canal for moderate occlusion • Eliminates feedback
• SAV included
#41A ADV. DESIGN FREE FIELD
• CANAL-LOK STYLE
• Functions identical to #21A
#41B ADV. DESIGN FREE FIELD
• CANAL-LOK STYLE
• Functions identical to #21B
#41C ADV. DESIGN FREE FIELD
• CANAL-LOK STYLE
• Functions identical to #21C
#23 - Solid, Non-Floating
• Full Shell Style
• Glossy Finish
• M35 Silicone [Translucent Colors]
#23A - Solid, Non-Floating w/Handles
• Full Shell Style
• Glossy Finish
• M35 Silicone [Translucent Colors]
#23B - Solid, Non-Floating w/Cord
• Full Shell Style
• Glossy Finish
• M35 Silicone [Translucent Colors]
#23C - Solid, Non-Floating w/Cord
• Full Shell Style
• Glossy Finish
• M35 Silicone [Translucent Colors]
#24 - Solid, Floating
• Full Shell Style
• Glossy Finish
• M35 Silicone [Translucent Colors]
#24A - Solid, Floating w/Handles
• Full Shell Style
• Glossy Finish
• M35 Silicone [Translucent Colors]
#24B - Solid, Floating w/Cord
• Full Shell Style
• Glossy Finish
• M35 Silicone [Translucent Colors]
#24C - Solid, Floating w/Handels + Cord
• Full Shell Style
• Glossy Finish
• M35 Silicone [Translucent Colors]
#26 - Skeleton Uplift
• Full Shell Style
• Glossy Finish
• M35 Silicone [Translucent Colors]
#27 - Canal Shell Uplift
• Full Shell Style
• Glossy Finish
• M35 Silicone [Translucent Colors]
#30C - Earmold for AirPods Pro^®
• Skeleton Style
• Compatible with Apple^® products
• Apple® Models: EarPods^®, AirPods^®, AirPods Pro^®
• Glossy Finish
• M35 Silicone [Translucent Colors]
#30A - Earmolds for Earphones
• Canal Style
• Compatible with most earphones
• Default Style for Sennheiser^® earphones
• Sennheiser^® Models: 80S, 80S BT, 800S
• Glossy or Matte Finish
• M35 Silicone [Translucent Colors]
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Have you selected a RIC earmold?*
- Yes - I have selected a RIC Earmold.