Cochlear Implant Support Request

Request a free consultation with a cochlear implant specialist from Advanced Bionics.

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Thank you for contacting us to assist with your hearing solutions. Count on us—a community of hearing health professionals and recipients of cochlear implants—to help you Hear and Be Heard™. A representative from Advanced Bionics will be in touch soon!

If your request needs immediate attention or you have additional questions, please contact Hear@AdvancedBionics.com.
Toll Free Phone: +1.866.844.HEAR (4327) US and Canada

Store Information

Clinic Name

"Referring HCP Name" must be provided.

Clinic Email

Customer Information

Customer First Name

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Customer Last Name

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Zip/Postal Code

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Telephone

Customer Phone Number

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Customer Email Address

"Customer Email" must be provided.

Privacy Notice I acknowledge that I, as a healthcare provider covered under the Health Insurance and Portability and Accountability Act (HIPAA), (a) have provided a Notice of Privacy Practices to the client, and (b) have obtained appropriate consent as may be required to disclose Protected Health Information (PHI) to Advanced Bionics and/or its subsidiaries and affiliates, for the purpose of independently providing information on Advanced Bionics’ products and services to the patient.

For more information, please visit Advanced Bionics’ Privacy Policy.

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