HP | Swim | Earbud Tips

Hearing Protection, Swim Plugs, and Custom Earbud Sleeves

Please read before ordering

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
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)*
Return Impressions
Use impressions from previous order #
Is this a REMAKE.*
If a remake, a full explanation is required. *Please return original guarantee.
Reason for Remake.
Are you mailing your impressions?*
- YES
- NO
Are you uploading 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, hps, 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, 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 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: 128 MB.
Special Instructions

Step 2: Shipping Details
Use Your Own Account (Optional)
- FedEx
- UPS
Your Account Number
Your Account Number
Ship to Office or Patient?*
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
Select Shipping Method
- Ground
- 2nd Day Air
- Next Day Air
- USPS Regular
- USPS Priority Mail
SAME-DAY LAB SHIPPING
You are submitting a "Same Day Lab" order.
This includes Overnight Shipping. [$28]
You are submitting a "Same Day Lab" order.
This includes Overnight Shipping. [$28]
This field is hidden when viewing the form
Use Your Own Account (Optional)
- Fed Ex
- UPS
This field is hidden when viewing the form
Your Account Number
Special Mailing Instructions

Step 3: Earmold Styles & Acoustic Options
Hearing Protection
Occupational Hearing Earmolds
Neon-Lite™ Swim Molds
Earbuds
This field is hidden when viewing the form
Earbud Model / Description*
Earbud Model / Description*
Options
- Helix Curl OFF (default)
- Helix Curl ON
- Buff Helix as marked
- Tragus
- Taper Canal
- Double Dip
Special Instructions
I have selected a product.*
- Yes / Next

HP | Swim | Earbud Tips

Hearing Protection, Swim Plugs, and Custom Earbud Sleeves

Step 1: Patient, Audiologist, and Impression Details

Step 2: Shipping Details

SAME-DAY LAB SHIPPING

Step 3: Earmold Styles & Acoustic Options

Step 4. Materials and Color Options

STEP 5: Finishing, Tubing, and Assembly options

Step 6: Rate Your Experience