Custom Earmolds for Hearing Aids Custom Earmolds for Hearing Aids This field is hidden when viewing the formOrder NumberAccount Number*Format: AA12345 Step 1: Patient, Audiologist, and Impression DetailsDateSame-Day Lab Process & Same-Day Express ShippingAll "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 CodeBuying Group NamePO# (If applicable)Medicare/Medicaid# (If applicable)Patient Name* First Last Audiologist Name* Au.D.Ph.D.M.A.M.S.Dr.Mr.Mrs.Ms. Prefix First Last Audiologist Email* Audiologist Phone (USA)*Audiologist Phone (International)Impressions (R/L)*Left & RightLeftRightUse impressions from previous orderReturn ImpressionsNo (Default)YesIs this a REMAKE?*NOYESMailing ear impressions.*YesNoThis field is hidden when viewing the formAre you mailing impressions?* YES NO Reason for Remake.A full explanation is required. *Please return original guarantee.I am uploading my 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®Impression ScansOtoscan® Package ID NumberUpload Impression Scans Drop files here or Select files Accepted file types: zip, stl, asc, Max. file size: 512 MB. Impression Quality Standard It is important to submit a complete and accurate impression. 1GB upload limit.Upload LANTOS Scans Drop files here or Select files Accepted file types: zip, stl, asc, Max. file size: 512 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 Select files Accepted file types: zip, stl, asc, hps, Max. file size: 512 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 PhotosSupported file-types: .jpg .png .psd .doc .docx .pdf .xlsx .xls .tif .tiff .txt Drop files here or Select files Accepted file types: jpg, png, psd, doc, docx, pdf, xlsx, xls, tif, tiff, Max. file size: 512 MB. Special Instructions Step 2: Shipping DetailsShip to Office or Patient?*Ship to Main OfficeShip to Satellite OfficeShip to PatientSelect Shipping Method Ground 2nd Day Air Next Day Air USPS Regular USPS Priority Mail Use Your Own Account (optional) FedEx UPS Your Account NumberYour Account NumberMain Office NamePatient Name First Last Satellite Office NameMain Office Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of 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PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Patient Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Special Mailing InstructionsSAME-DAY LAB SHIPPINGYou are submitting a "Same Day Lab" order. This includes Overnight Shipping. [$28] Step 3: Earmold StylesLogos & Special Shapes and MULTI-COLOR earmold options are only available with Signature BTE Earmolds.I'd like to order Titanium Earmolds.NoYesPlease call us to place an order for Titanium Earmolds: 800-523-7672View Titanium EarmoldsClick on the images below to reveal dropdown menus for product selection. You must select a product to proceed.*Styles Signature BTE w/#13 Tubing,Slim (thin) Tube, or RIC Standard Earmoldsfor RIC / Slim (thin) Tube Standard Occluding Styles w/#13 Tubing Standard Non-Occluding Styles w/#13 Tubing & Slim (thin) Tube Other Custom Earmolds This portal is for STANDARD Earmolds for RIC & Slim Tube. Earmold Materials available: Silicone, Heat-Cured, Synth-A-Flex, and Acrylic You will be limited in your color choices/styles to Solid Colors, Tint, and Clear. To find our new line of CIC-Style RIC Earmolds, please return to AUD ORDERING [Main Nav] and select SIGNATURE RIC EARMOLDS.This field is hidden when viewing the formSignature CIC Style for RIC / Slim (thin)Tube#BF4 - Lilly#CV5 CAVERN-LOK# CV4 CAVERN#CVO5 OPEN CAVERN-LOK#CVO4 OPEN CAVERNStandard Earmolds for RIC / Slim (thin) Tube *#OF2 - OPEN-FIT SKELETON (w/IROS) (w/slim tube)#SL2 - SLIM-FIT SKELETON (specify vent size + receiver model)#OF4 - OPEN-FIT CANAL (w/IROS) (w/slim tube)#SL4 - SLIM-FIT CANAL (specify vent size + receiver model)#OF5 - OPEN-FIT CANAL-LOK (w/IROS) (w/slim tube)#SL5 - SLIM-FIT CANAL-LOK (specify vent size + receiver model)#SL6 - SLIM-FIT SHELL#OF7 - OPEN-FIT CANAL-SHELL (w/IROS) (w/slim tube)#SL7 - SLIM-FIT CANAL-SHELLThis portal is for STANDARD OCCLUDING Earmolds w/#13 Tubing. Earmold Materials available: Silicone, Acrylic, Vinyl-Flex, Heat-Cured, Synth-A-Flex You will be limited in your color choices/styles to Solid Colors, Tint, and Clear. No Logos & Special Shapes. To order color styles for earmolds that include, Solid Colors, Rainbow/Swirl, Gel-e-burst™, Marble, Polka-dots, Glitters, etc., please select the SIGNATURE BTE order form on this page.Standard Occluding Styles *#1 Regular#1A REGULAR WITH TUBING#2 SKELETON#2B ½ SKELETON#3 SEMI-SKELETON#4 CANAL#5 CANAL-LOK#5A CANAL WITH HELIX#5L CANAL WITH LONG LOK#6 SHELL#7 CANAL SHELL#7A 3/4 SHELLThis portal is for STANDARD NON-OCCLUDING Earmolds w/#13 Tubing. Earmold Materials available: Silicone, Acrylic, Vinyl-Flex, Heat-Cured, Synth-A-Flex You will be limited in your color choices/styles to Solid Colors, Tint, and Clear. No Logos & Special Shapes. To order color styles for earmolds that include, Solid Colors, Rainbow/Swirl, Gel-e-burst™, Marble, Polka-dots, Glitters, etc., please select the SIGNATURE BTE order form on this page.Standard Non-Occluding w/#13 Tubing & Slim (thin) Tubes *#16 CROS A (no vent)#17 CROS B (no vent)#18 CROS C (no vent)#21A ADV. DESIGN FREE FIELD#21B ADV. DESIGN FREE FIELD#21C ADV. DESIGN FREE FIELD#41A ADV. DESIGN FREE FIELD# 41B ADV. DESIGN FREE FIELD# 41C ADV. DESIGN FREE FIELDThis portal is for SIGNATURE BTE Earmolds Earmold Material available: Silicone You will find earmold color options here that include, Solid Colors, Rainbow/Swirl, Gel-e-burst™, Marble, Polka-dots, glitters, and Glow-in-the-dark. Signature Earmold Pricing will apply. You can order Logos & Special Shapes here. If you are only ordering solid colors, tint, or clear earmolds, please use the STANDARD Occluding or Non-Occluding order forms on this page. Signature BTE w/#13 Tubing, Slim (thin) Tube, or RIC *#1A REGULAR WITH TUBING#2 SKELETON#2A ¾ SKELETON#2B ½ SKELETON#OF2 OPEN-FIT SKELETON#SL2 SLIM-FIT SKELETON#3 SEMI-SKELETON#4 CANAL#SL4 SLIM-FIT CANAL#OF4 OPEN-FIT CANAL#5 CANAL-LOK#SL5 SLIM-FIT CANAL-LOK#5A CANAL WITH HELIX#5L CANAL WITH LONG LOK#OF5 OPEN-FIT CANAL-LOK#6 SHELL#SL6 SLIM-FIT SHELL#7 CANAL SHELL#7A 3/4 SHELL#OF7 OPEN-FIT CANAL SHELL#SL7 SLIM-FIT CANAL SHELL#17 CROS B#21A - ADVANCED DESIGN FREE FIELD (with SAV)#21B - ADVANCED DESIGN FREE FIELD (with SAV)#21C - ADVANCED DESIGN FREE FIELD (with SAV)#41A - CANAL-LOK ADV. DESIGN FREE FIELD (with SAV)#41B - CANAL-LOK ADV. DESIGN FREE FIELD (with SAV)#41C - CANAL-LOK ADV. DESIGN FREE FIELD (with SAV)This portal is for OTHER Custom Earmolds. Earmold Material available: Acrylic You will find Canal Uplifts in clear Acrylic only. Other Custom Earmolds#26 - Skeleton Uplift#27 - Canal Shell Uplift #BF4 Lilly Features: • Discreet CIC Style • Venting (optional) • RIC Only • Recessed, position at 2nd bend • Built-in Universal Connector for Receiver • Translucent with matte • Platinum Silicone Material • M60 #CV5 CAVERN-LOK Description • CIC Style, Occluding • RIC or SLIM (Thin) TUBE • Discreet Retention Lock (recommended) • Silicone #CV4 CAVERN Description • CIC Style, Occluding • RIC or SLIM (Thin) TUBE • No Retention Lock • Transparent Tint • Silicone #CV05 OPEN CAVERN-LOK • CIC Style, Open-Fit • RIC or SLIM (thin) TUBE • Discreet Retention Lock (recommended) • Transparent Tint • Silicone #CVO4 OPEN CAVERN • CIC Style, Open-Fit • RIC or SLIM (Thin) TUBE • No Retention Lock • Transparent Tint • Silicone #1 REGULAR • Logo N/A • Special Shape N/A Special Notes: • Occluding • Used with external receiver that snaps into earmold #1A REGULAR W/TUBING • Logo N/A • Special Shape N/A Special Notes: • Occluding • Used with external receiver that snaps into earmold#1A REGULAR W/TUBING • Logo $6.00 • Special Shape $9.50 Special Notes: • Occluding • 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 • Logo N/A • Special Shape N/A • RIC & Slim (thin) Tube#SL2 SLIM-FIT SKELETON • Logo N/A • Special Shape N/A • RIC & Slim (thin) Tube#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 • Logo N/A • Special Shape N/A • RIC & Slim (thin) Tube#OF4 OPEN-FIT CANAL • Logo N/A • Special Shape N/A • RIC & Slim (thin) Tube#5 CANAL-LOK • Logo N/A • Special Shape N/A#SL5 SLIM-FIT CANAL-LOK • Logo N/A • Special Shape N/A • RIC & Slim (thin) Tube#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 • Logo N/A • Special Shape N/A • RIC & Slim (thin) Tube#6 SHELL • Logo N/A • Special Shape N/A#6 SHELL • Logo $6.00 • Special Shape $9.50#SL6 SLIM-FIT SHELL • Logo $6.00 • Special Shape $9.50 • RIC & Slim (thin) Tube#SL6 SLIM-FIT SHELL • Logo N/A • Special Shape N/A • RIC & Slim (thin) Tube#7 CANAL SHELL • Logo N/A • Special Shape N/A#7 CANAL SHELL • Logo N/A • Special Shape N/A#7A 3/4 SHELL • Logo N/A • Special Shape N/A#7A 3/4 SHELL • Logo $6.00 • Special Shape $9.50#OF7 OPEN-FIT CANAL SHELL • Logo N/A • Special Shape N/A • RIC & Slim (thin) Tube#SL7 SLIM-FIT CANAL SHEL • Logo N/A • Special Shape N/A • RIC & Slim (thin) Tube#17 CROS B • Logo N/A • Special Shape N/A#21A ADV. DESIGN FREE FIELD • Logo N/A • Special Shape N/A • S.A.V. included#21B ADV. DESIGN FREE FIELD • Logo N/A • Special Shape N/A • S.A.V. included#21C ADV. DESIGN FREE FIELD • Logo N/A • Special Shape N/A • S.A.V. included#41A ADV. DESIGN FREE FIELD • Logo N/A • Special Shape N/A • CANAL-LOK Style#41B ADV. DESIGN FREE FIELD • Logo N/A • Special Shape N/A • CANAL-LOK Style#41C ADV. DESIGN FREE FIELD • Logo N/A • Special Shape N/A • CANAL-LOK Style#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) • Acrylic Only - $42.00 • Completely open canal • Designed for CROS & many IROS fittings • Canal-Long Lok Style.#17 CROS B (open 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]#27 - Canal Shell Uplift • Acrylic Only#26 - Skeleton Uplift • Acrylic Only#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]Special Style Instructions Step 4: Acoustics & Physical OptionsVentingNo Vent [Default]Small .031Med .062Large .094IROSCanal LengthMedium [Default]ShortLongSound BoreStandard Bore [Default]Belled BoreHorn BoreAcoustic ModifierThis field is hidden when viewing the formIROSNo [Default]SmallMediumLargeSelective Vent (SAV)No [Default]YesOptions Helix Curl OFF (unless specified) Helix Curl ON Buff Helix as marked Tragus Taper Canal Double Dip Feedback Ring Options Helix Curl OFF (unless specified) Helix Curl ON Buff Helix as marked Tragus Taper Canal Double Dip Special Instructions STEP 5: Materials and Color OptionsAll selections on this page are included in the price of Signature Earmolds only.Special Instructions1. Platinum SeriesUplift MaterialAcrylic OnlyAcrylic Choose a Platinum materialSlikFit™ [Matte]Platinum M25 (Clear Only)Platinum M35 (M2000™)Platinum M45Choose a Platinum colorClearIced TeaRedBlueBlackPinkTintBeigeYellowOrangeWhitePurpleInvisiEarBrownGreenTurquoiseBlue TintFLUXX Green2. Signature ColorsChoose a Signature color styleChoose a Signature color styleSOLID [Select ONE color]Rainbow (Swirl) [2 to 5 colors)Gel-E-Burst [Clear + Up to 4 colors]Marble [White + Up to 4 colors]Polka-dots [1 main + Up to 4 colors]Signature Colors (Included)Select up to 5 colors, depending on color style selected. Clear Iced Tea Red Blue Black Pnk Tint Beige Yellow Orange White Purple InvisiEar Brown Green Turquoise Blue Tint FLUXX Green Choose a colorChoose a colorClearIced TeaRedBlueBlackPinkTintBeigeYellowOrangeWhitePurpleInvisiEarBrownGreenTurquoiseBlue TintFLUXX Green3. Custom Color* There is an additional charge of $5 per/earmold" per/custom color.Want a custom color?Describe it here:4. Other Options3. Synth-A-FlexAdd Glow in the DarkYesAdd GlitterNo additional charge MULTI Crystal Silver Gold Blue Purple Pink Black Orange Green 2. Heat CuredChoose a Heat Cured materialMedi-Sil™ Heat Cure SiliconeMedi-Sil Plus™Heat Cure SiliconeChoose a Heat Cured colorClearTint (rose) [Default]BeigeIce-teaBrown3. Other MaterialsOther material optionsSynth-A-FlexAcrylicChoose a colorTint [Default]ClearThis field is hidden when viewing the formChoose a colorRedBluePinkTintYellowOrangeWhitePurpleGreenTurquoise3. Vinyl-Flex4. Vinyl-Flex3. Synth-a-flexChoose a materialSynth-A-Flex™Choose a colorTint [Default]Clear4. AcrylicChoose a material (Acrylic)AcrylicChoose Vinyl-FlexVinyl-FlexThis field is hidden when viewing the formChoose a colorChoose a colorRedBluePinkTintYellowOrangeWhitePurpleGreenTurquoiseChoose a color (Acrylic)Tint [Default]Clear4. Other MaterialsChoose a materialAcrylicSynth-A-Flex™Choose a materialAcrylicSynth-A-Flex™Choose a colorTint [Default]ClearThis field is hidden when viewing the formChoose a colorRedBluePinkYellowOrangeWhitePurpleChoose other material options - LISTSuper Alerite™ Heat Cure AcrylicVinylflexPolyethylene (opaque pink only)Super Alerite w/Silky Sil. CanalAcrylic Body w/Synth-A-Flex CanalAcrylic Body w/Vinylflex CanalChoose a colorChoose a colorClear [Default]Tint (rose)BeigeIced-teaBrownSpecial InstructionsI have selected an earmold material.* Yes / Next STEP 6: Finishing and Assembly OptionsHearing Aid Type*BTE with #13 TubingBTE with Slim/thin TubeReceiver-In-Canal (RIC)HA Brand and Model____________________________________________Platinum Silicone FinishingStandard [Shiny]No GlazeNano-GlazeSlikFinish™ [Matte]Platinum Silicone FinishingStandard [Shiny]Nano-GlazeNo GlazeSlikFinish™ [Matte]Uplift FinishingAcrylic OnlyNO GLAZE [Default]Nano-GlazeHigh Shine [Hand Polish]Acrylic FinishingNo Glaze [Default]Nano-GlazeHigh Shine [Hand Polish]This field is hidden when viewing the formMedi-Sil™ FinishingNo Glaze [Default]Micro-GlazeSlikFinish™ [Matte]Medi-Sil / Medi-Sil Plus FinishingNo Glaze [Default]Nano Glaze (hypoallergenic)This field is hidden when viewing the formAcrylic / Super Alerite FinishingStandard [Default]Micro-GlazeNano Glaze (hypoallergenic)High ShinePlatinum Silicones FinishingNo Glaze [Default]Nano-Glaze [hypoallergenic]____________________________________________All tubing selections are included in the price of a Signature Earmold.Tube Type*Standard [Default]Non-Slim/Thin TubeDri-TubeHypoallergenicTubing ColorsCLEAR [Default]Tint (rose)BrownTubing ColorsCLEAR [Default]Tint (rose)BrownBEST MATCHRedBlueNeon PinkPurpleYellowGreenTube SizeThick [Default]MediumDouble WallTube TypeStandard [Default]Dri-TubeHypoallergenicTube BendSingle [Default]DoubleTubing AssemblyBest Match [Default]Gold LockThru CanalSilver LockMicroLokCementedTub-Lock-Plus™Invisilock™ [Not Available]Libby Horn3 mm (medium)3 mm (thick)4 mm (standard)C.F.A.12345A5B____________________________________________Add Ons Pull Cord Plastic Lanyard Fabric Cord EZ-Grip™ Handle (hearing protection & swim molds) This field is hidden when viewing the formAdd Ons for Standard Earmolds Pull Cord AccessoriesFor Standard Earmolds Dryer Kit EZ-Gel™ Starter Kit Add Ons Pull Cord Plastic Lanyard Fabric Cord Accessories Dryer Kit EZ-Gel™ Starter Kit Add Ons Pull Cord Accessories Dryer Kit EZ-Gel™ Starter Kit ____________________________________________Laser EngravingLeft & RightLeftRightInitialsOrder #First NameLast NameFirst Initial & Last NameMarking Only (no laser engraving)Color Code RED & BLUEColor Code REDColor Code BLUESpecial Shapes A-DBasketballBearCards symbol - clubCards symbol - diamondCards symbol - heartCards symbol - spadesCatChristian fishCloverCrescentCrossCrownDaisyDinasaur skullDogSpecial Shapes E-LFlamesDoubleFlip flopsFlowerFootballFootprintFrogGearsHeartHorseHorse headHorse shoeInfinity symbolJack o lanternLight bulbLightning BoltSpecial Shapes M-ZMicrosonic logoMoustacheMusic notePaw printPeace symbolPi symbolSea horseSharkSoccerballStarStar fishStar of DavidSwiss crossTruckUnicorn headVelociraptorDo you have a special shape? Describe it below.Upload your image or logo here. Drop files here or Select files Accepted file types: jpg, jpeg, png, psd, ai, tif, tiff, pdf, Max. file size: 512 MB. Image & Logo Guide Logos are only available on Full-shell Earmolds. Our designers will approximate your uploaded image or logo. Please, NO PROTECTED IMAGES or LOGOS.This field is hidden when viewing the formAccessories Dryer Kit EZ-Gel™ Starter Kit Special Instructions Step 7: Rate Your Experience(Optional)Your online ordering experience.Very PoorPoorFairGoodExcellentMicrosonic's product quality.Very PoorPoorFairGoodExcellentMicrosonic's customer service.Very PoorPoorFairGoodExcellentAny comments or suggestions? {all_fields}
