HP | Swim | Earbud Tips Hearing Protection, Swim Plugs, and Custom Earbud Sleeves This field is hidden when viewing the formOrder NumberAccount Number*Format: AA12345 Step 1: Patient, Audiologist, and Impression DetailsDateSame Day Lab Process & Same Day Express ShippingAll "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 CodePO# (If applicable)Medicare/Medicaid# (If applicable)Patient Name* First Last Audiologist Name* Au.D.Ph.D.M.A.M.S.Dr.Mr.Mrs.Ms. Prefix First Last Audiologist Email* Audiologist Phone (USA)Audiologist Phone (International)Impressions (R/L)*Left & RightLeftRightReturn ImpressionsNo (Default)YesUse impressions from previous order #Is this a REMAKE.*NOYES REMAKES: To order an earmold remake, you may 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®Impression ScansOtoscan® Package ID NumberUpload Impression Scans Drop files here or Select files Accepted file types: zip, stl, asc, hps, Max. file size: 512 MB. Impression Quality Standard It is important to submit a complete and accurate impression. 1GB upload limit.Upload LANTOS Scans Drop files here or Select files Accepted file types: zip, stl, asc, Max. file size: 512 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 Select files Accepted file types: zip, stl, asc, Max. file size: 512 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 PhotosSupported file-types: .jpg .png .psd .doc .docx .pdf .xlsx .xls .tif .tiff .txt Drop files here or Select files Accepted file types: jpg, png, psd, doc, docx, pdf, xlsx, xls, tif, tiff, Max. file size: 512 MB. Special Instructions Step 2: Shipping DetailsUse Your Own Account (Optional) FedEx UPS Your Account NumberYour Account NumberShip to Office or Patient?*Ship to Main OfficeShip to Satellite OfficeShip to PatientMain Office NamePatient Name First Last Satellite Office NameMain Office Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte 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TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da 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BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Select Shipping Method Ground 2nd Day Air Next Day Air USPS Regular USPS Priority Mail SAME-DAY LAB SHIPPINGYou 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 formUse Your Own Account (Optional) Fed Ex UPS This field is hidden when viewing the formYour Account NumberSpecial Mailing Instructions Step 3: Earmold Styles & Acoustic OptionsHearing Protection#50 - LifePlugs® - Standard [vented] • Hollow Canal#51 - LifePlugs® - Surfer [ventless] • Hollow Canal#52 - LifePlugs® - Sleep [ventless] • Hollow • M25 ONLY#53 - LifePlugs® - Riders [ventless] • Hollow Canal#54 - LifePlugs® - Dental [vented]. • Hollow Canal#P10 - PULSE musician’s earplugs w/10dB filters • Canal#P15 - PULSE musician’s earplugs w/15dB filters • Canal#P25 - PULSE musician’s earplugs w/25dB filters • Canal#P30 - PULSE musician’s earplugs w/30dB solid-filters • CanalP10 - 10dB Filters for PULSE earplugs (2)P15 - 15dB Filters for PULSE earplugs (2)P25 - 25dB Filters for PULSE earplugs (2)P30 - 30dB Filters for PULSE earplugs (2)#22 - Shell#22A - Shell w/Handles#22B - Shell w/ Cord#22C - Shell w/Handles and Cord#22DA - Shell - Vented w/Acoustic Filters A (NRR 11 dB)#22DB - Shell - Vented w/Acoustic Filters B (NRR 19 dB)#64 - Sonicguard+ | Full Shell | Electronic HP#H-1 - HunterEars Electronic HP - Full Shell AcrylicOccupational Hearing Earmolds#25 - Anesthesiologist mold • Shell (tubing adaptor, vent)#28 - Pilot’s Comm • Shell with crimped bar#28A - Pilot’s Comm • Shell with straight bar#29A - Hearing Aid/Conventional Stethoscope Adapter • Shell#33 - Comm/Broadcaster • Cross B (#17 coiled tube, clip & female conn.)#36 - Comm Earpiece • Shell (tube, clip, female conn.)#38 - Comm Earpiece • Skeleton (tube, clip, female conn.)#42 - AuD Listening Tube • Shell (bell tip, 18" Thick tube)#42A - AuD Listening Tube • Skeleton (bell tip, 18" Thick tube)Neon-Lite™ Swim Molds#23 - Shell, non-floating#23A - Shell, non-floating, w/Handles#23B - Shell, non-floating, w/Cord#23C - Shell, non-floating, w/Handles & Cord#24 - Shell, Floating#24A - Shell, Floating, w/Handles#24B - Shell, Floating, w/Cord#24C - Shell, Floating, w/Handles & CordEarbuds#306 • Shell Earmolds for Earbuds (send earbuds)#304 • Canal Earmolds for Earbuds (send earbuds)#30-AP1 • AirPods (1st Generation): A1523, A1722#30-AP2 • AirPods (2nd Generation): A2032, A2031, A1602#30-AP3 • AirPods (3rd Generation): A2565, A2564, A2566#30-APP1 • AirPods Pro (1st Generation): A2084, A2083#30-APP2 • AirPods Pro (2nd Generation): A2931, A2699, A2698This field is hidden when viewing the formEarbud Model / Description*Earbud Model / Description*Options Helix Curl OFF (default) Helix Curl ON Buff Helix as marked Tragus Taper Canal Double Dip Special InstructionsI have selected a product.* Yes / Next Step 4. Materials and Color OptionsLifePlugs® Select LifePlugs® Material by Model LifePlugs® Standard [Vented] - Passguard™ LifePlugs® Surfer [Ventless] - Passguard™ LifePlugs® Sleep [Ventless] - M25 / 1-Color Solid LifePlugs® Riders [Ventless] - Passguard™ LifePlugs® Dental [Vented] - Passguard™ Choose Color Style (LifePlugs® Sleep / M25 / 1-Color / Solid)Choose Color Style (LifePlugs® Sleep / M25 / 1-Color / Solid)SOLID [1 color]Rainbow (Swirl) [3 colors]Choose colors according to Color Style selection.Choose colors according to Color Style selection. Beige Red Turquoise Black Purple Fluxx™ Green Yellow Green White Gold Orange Blue Brown Pink Silver GlitterAdd Glitter MULTI Crystal Silver Blue Purple Pink Black Orange Green Glow-In-The-DarkAdd Glow-In-The-DarkYesSound Defenders Select This field is hidden when viewing the formSound Defenders™ - Material Options - source SlikFit™ M35 M25 PassGuard™ Hearing Protection SoftGuard™ Hearing Protection Sound Defenders™ - Material Options SlikFit™ M35 M25 PassGuard™ Hearing Protection SoftGuard™ Hearing Protection Choose Color Styles for Passguard™ and Softguard™Choose Color Styles for Passguard™ and Softguard™SOLID [Select ONE color]Rainbow (Swirl) [2 to 5 colors)Marble [White + 1 color]Polka-dots [1 main + Up to 4 colors]Choose Color Styles for SlikFit™, M35, M25Choose Color Styles for SlikFit™, M35, M25Gele-e-eburstSOLID [Select ONE color]Rainbow (Swirl) [2 to 5 colors)Marble [White + 1 color]Polka-dots [1 main + Up to 4 colors]Choose colors according to Color Style selection.Choose colors according to Color Style selection. Beige Red Turquoise Black Purple Fluxx™ Green Yellow Green White Orange Blue Brown Pink Silver Choose colors according to Color Style selection.Choose colors according to Color Style selection. Clear Beige Red Turquoise Black Purple Fluxx™ Green Yellow Green White Orange Blue Brown Pink Silver Glow-In-The-DarkAdd Glow-In-The-DarkYesDouble Damped A & B Select Double Damped - Material OptionsSlikFit™M35Double Damped A & B ColorsChoose Color StyleSOLID [Select ONE color]Rainbow (Swirl) [2 to 5 colors)Gel-E-Burst [Clear + Up to 4 colors]Marble [White + 1 color]Polka-dots [1 main + Up to 4 colors]Choose colors according to Color Style selection.Choose colors according to Color Style selection. CLEAR Ice Tea Red Blue Black Pink Tint (Rose) Beige Yellow Orange White Purple Invisiear Brown Green Turquoise Blue Tint Fluxx™ Green GlitterAdd Glitter MULTI Crystal Silver Gold Blue Purple Pink Black Orange Green This field is hidden when viewing the formGlitterAdd GlitterMULTICrystalSilverGoldBluePurplePinkBlackOrangeGreenGlow-In-The-DarkAdd Glow-In-The-DarkYesNeon-Lite™ Floating Swim Molds Select Neon-Lite™ Floating Swim MoldsChoose Color StyleSOLID [Select ONE color]Rainbow (Swirl) [2 to 5 colors)Marble [White + 1 color]Polka-dots [1 main + Up to 4 colors]Choose colors according to Color Style selection.Choose colors according to Color Style selection. Beige Red Turquoise Black Purple Fluxx™ Green Yellow Green White Orange Blue Brown Pink Silver GlitterAdd Glitter MULTI Crystal Silver Gold Blue Purple Pink Black Orange Green This field is hidden when viewing the formGlitterAdd GlitterMULTICrystalSilverGoldBluePurplePinkBlackOrangeGreenGlow-In-The-DarkAdd Glow-In-The-DarkYesNeon-Lite™ Non-Floating Swim Molds Select Neon-Lite™ Non-Floating Swim MoldsChoose Color StyleSOLID [Select ONE color]Gel-E-Burst [Clear + Up to 4 colors]Rainbow (Swirl) [2 to 5 colors)Marble [White + 1 color]Polka-dots [1 main + Up to 4 colors]Choose colors according to Color Style selection.Choose colors according to Color Style selection. CLEAR Ice Tea Red Blue Black Pink Tint (Rose) Beige Yellow Orange Blue Tint White Purple Invisiear Brown Green Turquoise Fluxx™ Green GlitterAdd Glitter MULTI Crystal Silver Gold Blue Purple Pink Black Orange Green This field is hidden when viewing the formGlitterAdd GlitterMULTICrystalSilverGoldBluePurplePinkBlackOrangeGreenGlow-In-The-DarkAdd Glow-In-The-DarkYesThis field is hidden when viewing the formChoose colors according to Color Style selection.Choose colors according to Color Style selection. Beige Red Turquoise Black Purple Fluxx™ Green Yellow Green White Gold Orange Blue Brown Pink Silver PULSE® Musician's Earplugs Select PULSE™ Color StylesChoose Color StyleClear [Default]SOLID [Select ONE color]Rainbow (Swirl) [2 to 5 colors)Gel-E-Burst [Clear + Up to 4 colors]Marble [White + 1 color]Polka-dots [1 main + Up to 4 colors]Choose colors according to Color Style selection.Choose colors according to Color Style selection. CLEAR Ice Tea Red Blue Black Pink Tint (Rose) Beige Yellow Orange White Purple Invisiear Brown Green Turquoise Blue Tint Fluxx™ Green GlitterAdd Glitter MULTI Crystal Silver Gold Blue Purple Pink Black Orange Green This field is hidden when viewing the formGlitterAdd GlitterMULTICrystalSilverGoldBluePurplePinkBlackOrangeGreenGlow-In-The-DarkAdd Glow-In-The-DarkYesCustom Sleeves for Earbuds Select Custom Sleeves for EarbudsChoose Color StyleClear [Default]SOLID [Select ONE color]Rainbow (Swirl) [2 to 5 colors)Gel-E-Burst [Clear + Up to 4 colors]Marble [White + 1 color]Polka-dots [1 main + Up to 4 colors]Choose colors according to Color Style selection.Choose colors according to Color Style selection. CLEAR Ice Tea Red Blue Black Pink Tint (Rose) Beige Yellow Orange White Purple Invisiear Brown Green Turquoise Blue Tint Fluxx™ Green GlitterAdd Glitter MULTI Crystal Silver Gold Blue Purple Pink Black Orange Green This field is hidden when viewing the formGlitterAdd GlitterMULTICrystalSilverGoldBluePurplePinkBlackOrangeGreenGlow-In-The-DarkAdd Glow-In-The-DarkYesOccupational Hearing Earmolds Select Occupational Hearing Earmolds Platinum M35 (M2000™) Platinum SlikFit™ Synth-A-Flex™ Acrylic Choose one color.Choose one color. CLEAR Ice Tea Red Blue Black Pink Tint (Rose) Beige Yellow Orange White Purple Invisiear Brown Green Turquoise Blue Tint Fluxx™ Green Glow-In-The-DarkAdd Glow-In-The-DarkYesSpecial InstructionsI have selected an earmold material.* Yes / Next STEP 5: Finishing, Tubing, and Assembly optionsThis field is hidden when viewing the formEarmold Finishing OptionsAntibacterial GlazesSlikFinish™ - Matte Finish (Opaque Glaze)Glossy - Standard Finish (Clear Glaze)Finishing Special InstructionsAdd Ons Pull Cord Plastic Lanyard Fabric Cord EZ-Grip™ Handle (not available on swim plugs) Laser EngravingLeft & RightLeftRightInitialsOrder #First NameLast NameFirst Initial & Last NameMarking Only (no laser engraving)Color Code RED & BLUEColor Code REDColor Code BLUESpecial Shapes A-DBasketballBearCards symbol - clubCards symbol - diamondCards symbol - heartCards symbol - spadesCatChristian fishCloverCrescentCrossCrownDaisyDinasaur skullDogSpecial Shapes E-LFlamesDoubleFlip flopsFlowerFootballFootprintFrogGearsHeartHorseHorse headHorse shoeInfinity symbolJack o lanternLight bulbLightning BoltSpecial Shapes M-ZMicrosonic logoMoustacheMusic notePaw printPeace symbolPi symbolSea horseSharkSoccerballStarStar fishStar of DavidSwiss crossTruckUnicorn headVelociraptorDo you have a special shape? Describe it below.Upload your image or logo here. Drop files here or Select files Accepted file types: jpg, jpeg, png, psd, ai, tif, tiff, pdf, Max. file size: 512 MB. Image & Logo Guide Logos are only available with Full-shell Earmolds. Our digital engraver will approximate your uploaded image or logo.Accessories Dryer Kit EZ-Gel™ Starter Kit Step 6: Rate Your ExperienceYour online ordering experience.Very PoorPoorFairGoodExcellentMicrosonic's product quality.Very PoorPoorFairGoodExcellentMicrosonic's customer service.Very PoorPoorFairGoodExcellentAny comments or suggestions? {all_fields}
