Maintenance Agreement

By submitting your details, you are confirming that you agree with the Maintenance Agreement below.

Please read the Maintenance Agreement below and submit this form.

Full Name *

Reference Number *

Phone Number *

Have you chosen to enter into a Maintenance Agreement? *

Yes

Do you understand that the information provided on this form is required for the delivery of maintenance services under the Hearing Services Administration Act 1997? *

Yes

Maintenance Agreement

Maintaining your hearing devices and buying batteries can be costly. An easy and cost-effective way to help you take care of your hearing devices is to enter into an Australian Government subsidised Maintenance Agreement. A Maintenance Agreement will cover the costs of your device batteries and maintenance for 12 months, for which you may be asked to pay a co-payment. Your Maintenance Agreement may end early if you are fitted with new devices under the program. Maintenance Agreements are optional and do not cover device accessories.

For fully Subsidised Devices the client maintenance co-payment is set by the program and may increase each year. Bloom hearing specialists uses the same co-payment amount for all partially subsidised devices. The co-payment amount is the maximum you can be charged per Maintenance Agreement. Maintenance Agreements also cover all repairs for your devices.

The current maintenance co-payment is $53.85. Department of Veterans' Affairs (DVA) Gold or White (specific for hearing loss) card holders client's devices are exempt from paying the client maintenance co-payment. DVA clients must still agree to enter into a Maintenance Agreement.

Further information about maintenance agreements is available on the program website at http://www.hearingservices.gov.au

If you have any questions about the Maintenance Agreement, including when it will begin, please call your bloom Hearing Specialists clinic. This agreement will be held on your client file. You can ask for a copy of this form for your records.