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Loss & Damage Form

Please complete and sign this form to submit a loss and damage claim.

Below specify the products customer wants to file a Loss and Damage for. By filing for a Loss and Damage through, customer confirms that these products were initially purchased through and that this is the first Loss and Damage claim related to these products as specified.

Product Specification (Select all that apply):

Trial & Warranty Information:

Customer Acknowledgement:

  • Any Loss & Damage claim during the 45-day trial period will waive the remaining portion of the trial period.
  • Once the manufacturer replaces the initial devices, the replacement devices will not be able to be returned or exchanged.
  • Products delivered under Loss & Damage do not come with a separate or additional warranty period.
  • Products delivered under Loss & Damage do not extend the warranty of the initial devices purchased.
  • If customer finds lost/damaged device(s) after ordering replacement devices, the lost/damage device(s) will not be eligible for service/repair and the customer must surrender the lost/damage device(s) to the manufacturer


  • Loss & Damage replacement fee per hearing aid $250
  • Loss & Damage service provider fee $150 per instance
  • Standard Ear Molds $75 per mold | Power Ear Molds $150 per mold
  • Loss & Damage fee does not include replacement of charger. If a new charger is ordered, an additional fee of $149 will be assessed.
  • Taxes may apply.

The fees associated with a Loss & Damage claim are final and non-refundable, including any applicable taxes. Filing a Loss & Damage claim voids any remaining trial periods for that device and the sale is final.

By signing below, customer agrees to the above-mentioned terms and authorizes the payment for the loss and damage fees to the card on file.

*If the customer desires a different payment method than we have on file, please call Customer Service to check eligibility at:
(888) 780-3450. founders

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