DYNAMIC SETUP FRAMEWORK FORM



Select a Framework

Framework 1
Framework 2
Framework 3
Framework 4
Framework 5
Framework 6
Framework 7
Framework 8


Business Name



Office Locations

(Please include Address, Phone Number, Fax Number, E-mail)



Description of the Practice and Introduction



Biographies for each Professional and Staff Member

Please indicate location at which each individual works.
(Name, Professional Qualifications, Narrative)



Services Offered (per location)



Testimonials

Please provide scan of handwritten note or typed text and photos if available.



Additional Content

Please provide additional written content you would like to include such as FAQs, background information, upcoming events, specials and discounts if available.



Additional Information and Comments



Affiliations and Social Media

Business and Professional Affiliations

Other



Social Media Presence (Please indicate social media for your practice)

Facebook
Twitter
Linkedin
Google Plus
Instagram
Pinterest
Flickr
Youtube

Other



Please provide logo in Vector format



Color Scheme

Please select the 4 principal colors you would like to incorporate into the design





Slide and Stock Photos (Please select any stock photos you desire to use)

AL-SP-0001
AL-SP-0002
AL-SP-0003
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AL-SP-0005
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AL-SP-0382
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AL-SP-0385
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AL-SP-0388
AL-SP-0389
AL-SP-0390
AL-SP-0391
AL-SP-0392
AL-SP-0393
AL-SP-0394
AL-SP-0395
AL-SP-0396
AL-SP-0397
AL-SP-0398
AL-SP-0399
AL-SP-0400
AL-SP-0401
AL-SP-0402
AL-SP-0403
AL-SP-0404
AL-SP-0405
AL-SP-0406
AL-SP-0407
AL-SP-0408
AL-SP-0409
AL-SP-0410
AL-SP-0411
AL-SP-0412
AL-SP-0413
AL-SP-0414
AL-SP-0415
AL-SP-0416
AL-SP-0417
AL-SP-0418
AL-SP-0419
AL-SP-0420
AL-SP-0421
AL-SP-0422
AL-SP-0423
AL-SP-0424
AL-SP-0425
AL-SP-0426
AL-SP-0427
AL-SP-0428
AL-SP-0429
AL-SP-0430
AL-SP-0431
AL-SP-0432
AL-SP-0433
AL-SP-0434
AL-SP-0435
AL-SP-0436
AL-SP-0437
AL-SP-0438
AL-SP-0439
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AL-SP-0446
AL-SP-0447
AL-SP-0448
AL-SP-0449
AL-SP-0450
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AL-SP-0453
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AL-SP-0455
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AL-SP-0457
AL-SP-0458


Product Selection

Please select the Oticon Hearing Aids which you currently carry.

Oticon-Acto
Oticon-Agil
Oticon-Alta
Oticon-Alta2
Oticon-Chili
Oticon-Dynamo
Oticon-Get
Oticon-Ino
Oticon-Intiga
Oticon-Invisible-Intiga
Oticon-Nera
Oticon-Nera2
Oticon-Opn
Oticon-Ria
Oticon-Ria2
Oticon-Safari-SP
Oticon-Sensei
Oticon-Siya
Oticon-Sumo-DM

Please select the Phonak Hearing Aids which you currently carry.

Phonak-Ambra
Phonak-Audeo-B
Phonak-Audeo-Marvel
Phonak-Audeo-MINI
Phonak-Audeo-Q
Phonak-Audeo-S
Phonak-Audeo-SMART
Phonak-Audeo-V
Phonak-Audeo-YES
Phonak-Bolero-B
Phonak-Bolero-Q
Phonak-Bolero-V
Phonak-Cassia
Phonak-Certena-Art
Phonak-CROS-B
Phonak-CROS-II
Phonak-CROS
Phonak-Dalia
Phonak-Exelia-Art
Phonak-Lyric
Phonak-Milo-Plus
Phonak-Naida-Q
Phonak-Naida-S
Phonak-Naida
Phonak-Nios-micro
Phonak-Nios-S-H2O
Phonak-Sky-Q
Phonak-Solana
Phonak-Una
Phonak-Versata-Art
Phonak-Virto-B-Titanium
Phonak-Virto-B
Phonak-Virto-Q
Phonak-Virto-V

Please select the ReSound Hearing Aids which you currently carry.

Resound-Alera-TS
Resound-Alera
Resound-dot2
ReSound-Enya
Resound-ENZO-3D
Resound-Enzo
ReSound-Enzo2
Resound-LiNX-3D-Rechargeable
Resound-LiNX-3D
Resound-LiNX-Quattro
Resound-LiNX
Resound-LiNX2
Resound-Live
Resound-Magna
Resound-Sparx
Resound-Vea
Resound-Verso TS
Resound-Verso

Please select the Siemens/Signia Hearing Aids which you currently carry.

Siemens-Ace-binax
Siemens-Ace
Siemens-Aquaris
Siemens-Carat-binax
Siemens-Carat
Siemens-Eclipse
Siemens-Insio-binax
Siemens-Insio
Siemens-Life
Siemens-Motion-binax
Siemens-Motion
Siemens-Nitro-BTE
Siemens-Nitro-Customs
Siemens-Orion-2
Siemens-Orion-ITE
Siemens-Pure-binax
Siemens-Pure
Siemens-Sirion-2
Siemens-Sirion-ITE
Signia-Intuis-3
Signia-Nx
Signia-Pure-Primax
Signia-Styletto

Please select the Widex Hearing Aids which you currently carry.

Widex-Baby
Widex-Beyond
Widex-Clear
Widex-Cros
Widex-Dream
Widex-Evoke
Widex-Menu
Widex-Mind
Widex-Super
Widex-Unique


Additional information about Hearing Aids carried