Good health practice requires that a person with a hearing loss have a medical evaluation by a licensed physician (preferably a physician who specializes in diseases of the ear) before purchasing a hearing aid.  Licensed physicians who specialize in diseases of the ear are often referred to as otolaryngologists, otologists or otorhinolaryngologists. The purpose of a medical evaluation is to assure that all medically treatable conditions that may affect hearing are identified and treated before the hearing aid is purchased.

We advise all prospective hearing aid buyers to consult promptly with a licensed physician (preferably an ear specialist) immediately if you have any of the following conditions:

(i) Visible congenital or traumatic deformity of the ear.

(ii) History of active drainage from the ear within the previous 90 days.

(iii) History of sudden or rapidly progressive hearing loss within the previous 90 days.

(iv) Acute or chronic dizziness.

(v) Unilateral (one ear only) hearing loss of sudden or recent onset within the previous 90 days.

(vi) Audiometric air-bone gap equal to or greater than 15 decibels at 500 hertz (Hz), 1,000 Hz, and 2,000 Hz.

(vii) Visible evidence of significant cerumen accumulation or a foreign body in the ear canal.

(viii) Pain or discomfort in the ear.

FDA Regulations

I have been advised by HearSource.com & any or all representatives, that the Food and Drug Administration has determined that my best health interest would be served if I had a medical evaluation by a licensed physician ( preferably a physician who specializes in diseases of the ear ) before purchasing a hearing aid.

I do not wish a medical evaluation before purchasing a hearing aids.

Waiver Signature ____________________________________   Date _______________