CI Network Support Request

Customer State/Province

Country

Customer Primary Language

Consultation Options (Select all areas of interest) In-Clinic - 1:1 Consultation In-Clinic - Group Consultation Cochlear Implant Recipient Virtual Call Consultation Phone consultation Email Consultation

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.

COCHLEAR IMPLANT ASSESSMENT REFERRAL

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