Date Ordered :
*
Hearing Clinic :
Client Name :
*
Contact Person :
Age :
Contact Number :
*
NRIC/ FIN No.
Required Date:
*
Transmitter Qty
Receiver Qty
inspiro
SmartLink+
ZoomLink+
EasyLink+
MLxi
MyLink +
(T-Coil required in hearing aids)
ML9i
(Exélia Art, Versáta,Certéna,Milo Plus)
ML 10i
(naida UP)
ML 11i
(naida SP)
ML 12i
(Nios micro, Milo Plus micro)
Microline Freedom
MicroLink CIS with MLxi
MLxi Baha
iSense micro
iSense Classic
AS9-MLxi
AS10
AS11
AS12
Exélia Art, Versáta,Certéna,Milo Plus
Naída UP
Naída SP
Nios micro, micro BTE
Receiver information (ML= Microlink, xi= inspiro Dynamic FM based, xS= Synchronization)
MLxi
ML9i
ML10i
ML11i
ML12i
iSense Micro
iSense Classic
MLxi Baha
MyLink+
MicroLink Freedom
MicroLink CI S
Special Instructions
Enter Security Code