Send Us Your Audiogram

Use this form to upload your audiogram.  The information will be used to recommend products and/or program your hearing aids.  

Upload file size limited to 10MB, formats: jpeg, jpg, png, gif, tiff, bmp, pdf.

(800) 416-2434

108 E. Pat Rady Way
P.O. Box 364
Bainbridge, IN 46105

Email medrecords@hearsource.com
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