HP | Swim | Earbud Tips

Hearing Protection, Swim Plugs, and Custom Earbud Sleeves

Please read before ordering

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.*
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 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 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
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