I acknowledge that I am 18 years of age or older and that I have been advised by Vital Ear 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. I do not wish a medical evaluation before purchasing a hearing aid.

Please consult an ear specialist or licensed physician if you experience any of the following:
- 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 last 90 days