Loss claim for sound processors

Complete this form to report a lost Cochlear™ Nucleus®, Nucleus Nexa®, Baha® or Osia® product. Submit a form for each product being claimed. Please read this form fully and complete all appropriate sections.

Your details

Relationship to patient

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Carer

Clinician

Patient information

First name

Last name

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Area code and number

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Address

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Information about the product being claimed

Please complete only for the sound processor being claimed. If more than one sound processor is being claimed, please complete a new form for each processor.

Sound processor

Nucleus / Nucleus Nexa Sound Processor

Kanso / Kanso Nexa Sound Processor

Baha Sound Processor

Osia Sound Processor

Explanation of loss

Please explain how the item was lost

Shipping details

Important: We cannot deliver to PO boxes

Same as above

Ship to a different address

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