FDA Waiver

I acknowledge that I am eighteen (18) years of age or older and Jabra Enhance has advised me 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 specializing in diseases of the ear) before purchasing a hearing aid. I do not wish for a medical evaluation before purchasing a hearing aid. I have also been advised that although any examination in connection with my purchase of hearing aid conducted by a Jabra Enhance audiologist or hearing aid dispenser may reveal no indicators mandating referral to a licensed physician, preferably one specializing in diseases of the ear, for medical evaluation as required by law, it is in my best health interest to be examined by a physician specializing in diseases of the ear for any medical condition or disease at least once every three (3) years. Lastly, I acknowledge that none of the below conditions or symptoms apply to me and that the existence of such conditions would prohibit Jabra Enhance from selling a hearing aid to me without medical clearance:

• visible congenital or traumatic deformity of the ear;
• history of, or active drainage from the ear within the previous ninety (90) days;
• history of sudden or rapidly progressive hearing loss within the previous ninety (90) days;
• acute or chronic dizziness;
• unilateral hearing loss of sudden or recent onset within the previous ninety (90) days;
• air bone gaps;
• visible evidence of bleeding, significant earwax accumulation, or a foreign body in the ear canal; or
• pain or discomfort in the ear.