Phonak hearing aids, pair
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720 Segoe Hollow Road, Suite 4
Madison, WI 53705
Vanderhoef Audiology (608) 555-0112
vanderhoefaudiology.example
Purchase Agreement and Invoice
Patient: Raymond C. Ostrander, date of birth 05/30/1953
Date of fitting: March 16, 2023
Audiologist: Kelsey Vanderhoef, Au.D.
Item Serial number Amount
Phonak Audeo Lumity L70-R, left 2302N4K8T $2,345.00
Phonak Audeo Lumity L70-R, right 2302N4K9B $2,345.00
Charger Case Go - $200.00
Fitting, real-ear measurement and follow-up visits for three years - included
Total, paid by check $4,890.00
Trial period
The aids may be returned within 45 days of the fitting for a refund of the purchase price less a
$250.00 fitting fee.
Warranty
Manufacturer's warranty for repairs, and loss and damage cover, for three years, to March 16,
2026. Each aid may be replaced once if lost or damaged beyond repair, with a deductible of
$350.00 for each aid. Reference PH-LD-230316-5582.
Insurance
Original Medicare and Medicare supplement plans do not pay for hearing aids. No claim has
been filed.
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The record values this file is made from: the ones its text names with {{record.field}}, and the fields its template reads. A value here is in the file's source; whether it is readable depends on the look.
| Value | Now |
|---|---|
| ray.date_of_birth | 1953-05-30 |
| receipt-hearing-aids.purchase_date | 2023-03-16 |
| receipt-hearing-aids.price | 4890.0 |
| warranty-hearing-aids.expiration | 2026-03-16 |
| warranty-hearing-aids.policy_number | PH-LD-230316-5582 |
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