I acknowledge that I am 18 years of age or older and that I have been advised by Club Hearing that the Food and Drug Administration (FDA) has determined that my best health interest would be served if I had a medical evaluation by a licensed physician (preferably a physician who specializes in diseases of the ear) before purchasing a hearing aid/device. I do not wish a medical evaluation before purchasing a hearing aid/device.

Additional Considerations:
If you have or think you may have any of the following conditions, Club Hearing advises you to consult promptly with a licensed physician (preferably an ear specialist) prior to purchase:
- Visible deformity of the ear
- Fluid or drainage from the ear within the past 90 days
- Sudden, rapidly progressing, or fluctuating hearing loss
- Spells of acute or chronic dizziness
- Hearing loss only on one side that worsened in the past 90 days
- Ear canal blockage, a lasting ear infection, or a plugged-up fullness feeling
- Excessive wax buildup, or a history of excessive wax buildup
- Pain or discomfort in the ear
- Ringing in one or both ears within the last 90 days

Hearing Aids:
You are purchasing a hearing aid based upon the information you have submitted to Club Hearing. Any examination or representation made by a hearing aid provider or audiologist in connection with the practice of dispensing, fitting, or dealing in hearing aids is not an examination, diagnosis, or prescription by a person licensed to practice medicine and, therefore, must NOT be regarded as medical opinion or advice. Hearing aids will NOT restore normal hearing, nor will they prevent further hearing loss. It is also recommended that an Otoscopic exam is performed before the purchase of a hearing aid.