Custom Earmolds for Hearing Aids

Please read before ordering

Custom Earmolds for Hearing Aids This online order form is for registered audiology customers with an existing account number. If you would like to set up an account, please give us a call or contact us here.

3D impression scans can be uploaded through this online order form. If you are mailing ear impressions, please include the first page of your online ORDER SUMMARY with the mailed-in impressions. Order Remakes by visiting our Customer Support Page

Order Number
Account Number*

Step 1: Patient, Audiologist, and Impression Details
Date
Same-Day Lab Process & Same-Day Express 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
Buying Group Name
PO# (If applicable)
Medicare/Medicaid# (If applicable)
Patient Name*
First Last
Audiologist Name*
Prefix First Last
Audiologist Email*
Audiologist Phone (USA)*
Audiologist Phone (International)
Impressions (R/L)*
Use impressions from previous order
Return Impressions
Is this a REMAKE?*
Mailing ear impressions.*
Hidden
Are 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® Package ID Number
Upload Impression Scans
Drop files here or

Accepted file types: zip, stl, asc, Max. file size: 100 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: 100 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: 100 MB.
Impression Quality Standard
It is important to submit a complete and accurate impression. 1GB upload limit.
Do you have any supporting documents or images?
- YES
Upload Supporting Documents and Images
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: 100 MB.
Special Instructions

Step 2: Shipping Details
Ship to Office or Patient?*
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
Main Office Name
Patient Name
First Last
Satellite Office Name
Main Office Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Satellite Office Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Patient Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Special Mailing Instructions
SAME-DAY LAB SHIPPING
You are submitting a "Same Day Lab" order.
This includes Overnight Shipping. [$28]

Step 3: Earmold Styles
Logos & Special Shapes and MULTI-COLOR earmold options are only available with Signature BTE Earmolds.
Click 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 Earmolds
  for 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

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.
Hidden
Signature CIC Style for RIC / Slim (thin)Tube
Standard Earmolds for RIC / Slim (thin) Tube *
This 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 *
This 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 *
This 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 *
This portal is for OTHER Custom Earmolds.
Earmold Material available: Acrylic

You will find Canal Uplifts in clear Acrylic only.
Other Custom Earmolds
#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 (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]
#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