Hearing Aid Service Agreement

HEARING AID SERVICE AGREEMENT

This Hearing Aid Service Agreement ("Agreement") is entered into on between Provider Name: and Client Name: .

WHEREAS

WHEREAS, Provider is duly qualified and experienced in the provision, fitting, maintenance and repair of hearing instruments and related accessories; and

WHEREAS, Client desires Provider to perform specified hearing aid services, including evaluation, fitting, adjustments, and on-going maintenance, subject to the terms and conditions set forth in this Agreement; and

WHEREAS, the parties intend to set forth the scope, payment terms, warranty, confidentiality and other obligations in writing.

SCOPE OF WORK

PAYMENT TERMS

Total Fee for Services and Devices: $

Balance due by: . Acceptable payment methods include cash, check, credit card, or other methods agreed in writing.

Late Payment: If any undisputed amount is not paid within days after the due date, a late fee of % per month on the outstanding balance will be charged, not to exceed the maximum allowed by law.

SERVICE, REPAIRS, AND WARRANTY

Manufacturer's warranty period (if applicable): . Provider also offers the following service warranty:

Repair Turnaround Time: Provider will use commercially reasonable efforts to complete in-warranty repairs within of receipt of the device, subject to parts availability.

Replacement Parts and Accessories: Parts and accessories supplied outside of warranty will be billed at Provider's prevailing rates unless otherwise stated.

TERM AND TERMINATION

Term Commencement Date: . Term End Date (if applicable):

Either party may terminate this Agreement for convenience upon written notice. Provider may suspend service immediately if Client fails to pay amounts due or if Client's conduct endangers staff or equipment.

CONFIDENTIALITY AND PATIENT INFORMATION

Provider and Client acknowledge that Client's medical and audiological information is confidential. Provider will maintain reasonable administrative, technical and physical safeguards to protect such information and will use and disclose it only as permitted by law and this Agreement. Provider may disclose information to technicians, manufacturers or insurance carriers as necessary to provide services or process claims.

LIMITATION OF LIABILITY; INDEMNIFICATION

Except to the extent caused by Provider's gross negligence or willful misconduct, Provider's liability for any claim arising out of or related to this Agreement or services performed shall be limited to direct damages not to exceed the total fees paid by Client under this Agreement. Provider shall not be liable for incidental, consequential, special or punitive damages. Client agrees to indemnify and hold Provider harmless from claims arising from Client's misuse or unauthorized modification of devices.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the state identified below. The parties submit to the exclusive jurisdiction of the state and federal courts located within that state for disputes arising under this Agreement.

ENTIRE AGREEMENT

This Agreement, together with any exhibits or addenda signed by the parties, constitutes the entire agreement between Provider and Client with respect to the subject matter hereof and supersedes all prior negotiations, representations and agreements, whether written or oral. No amendment or waiver shall be effective unless in writing and signed by both parties.

MISCELLANEOUS

Notices required or permitted under this Agreement shall be in writing and delivered to the addresses set forth above or to such other address as either party may designate in writing. If any provision of this Agreement is found unenforceable, the remaining provisions shall remain in full force and effect.

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