Section 25.210. Receipt, disclosure agreement and money back guarantee to purchaser—purchaser protection

(a) Receipt. Upon the sale of a hearing aid, the registrant shall provide the purchaser a signed receipt. The receipt may be made out on more than one sheet of paper and shall contain the following:

(1) The date of sale.

(2) The make, model and serial number or, if no serial number is applicable, an identification number of the hearing aid.

(3) The address of the principal place of business of the registrant.

(4) If the hearing aid is used or reconditioned, a statement which provides that information and which meets the requirements of § 25.215(23) (relating to denial, revocation or suspension of registrant’s certificate).

(5) The registrant’s registration certificate number.

(6) The terms of any guarantee or express warranty made to the purchaser with respect to the hearing aid.

(7) A copy of the written forms as required by § 25.211 (relating to medical recommendations; waiver forms).

(8) A statement on or attached to the receipt, in no smaller than 10 point type, as follows:

‘‘The purchaser has been advised at the outset of his relationship with the hearing aid dealer that any examination or representation made by a registered hearing aid dealer and fitter in connection with the practice of fitting and selling of this hearing aid, is not an examination, diagnosis or prescription by a person licensed to practice medicine in this Commonwealth and therefore must not be regarded as medical opinion.’’

(9) A statement on the face of the receipt, in no smaller than 10 point bold type, as follows: ‘‘If your rights are violated, you may contact the State Bureau of Consumer Protection, the Pennsylvania Department of Health in Harrisburg, or your local district attorney.’’

(b) Disclosure agreement and money back written guarantee. Before the provision of any service incidental to or connected with the potential sale of a hearing aid, the registrant shall provide a disclosure agreement and money back written guarantee to the prospective hearing aid user or authorized representative, and shall explain it in detail in accordance with subsection (c). This shall be in 10 point type or larger, and may be made out on more than one sheet of paper, but shall employ the following format or be on a form approved by the Department:

HEARING AID DISCLOSURE AGREEMENT/MONEY BACK GUARANTEE

(Business Name)

---

(Business Address)

---

Telephone No. ( )

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PART A.

Description of services included in fitting procedure or process, and sale and delivery of hearing aid.	FEE (State whether fee is waived if hearing aid purchased)	REFUNDABLE (Upon return of hearing aids)	NOT REFUNDABLE

THIS DISCLOSURE AGREEMENT WAS PROVIDED, PARTS A AND B WERE EXPLAINED, AND PART A (FEES FOR SERVICES NOT PART OF THE PRICE OF THE HEARING AID) WAS COMPLETED AT

---

(time) ON

---

(date), BEFORE ANY SERVICES WERE PROVIDED. PART B (CANCELLATION FEES THAT WILL BE INCURRED IF A HEARING AID IS RETURNED UNDER THE 30-DAY MONEY BACK GUARANTEE BELOW), WAS COMPLETED AND EXPLAINED AFTER SERVICES WERE PROVIDED AND BEFORE ANY PAYMENT WAS MADE. IF PART B IS NOT COMPLETED, IT IS BECAUSE A HEARING AID WAS NOT RECOMMENDED OR NOT DESIRED.

NOTHING IN THIS DISCLOSURE AGREEMENT SHALL RELIEVE A REGISTRANT OF THE OBLIGATION TO REFUND ALL OR PART OF THE ABOVE FEES, INCLUDING THOSE LISTED AS NOT REFUNDABLE, IF A COURT DETERMINES THAT THE REGISTRANT HAS VIOLATED A PENNSYLVANIA CONSUMER PROTECTION LAW IN THE SALE OR FITTING OF THE HEARING AID (OR SIMILAR DEVICE) AND IF THE COURT ORDERS SUCH REFUND.

Customer’s Signature	Registrant’s Signature

PART B.

HEARING AIDS & ACCESSORIES		DESCRIPTION of GOODS—include make, model, serial number(s)	PRICE	REFUNDABLE (upon return of hearing aid)	NOT REFUNDABLE (Cancellation Fee)
Hearing Aid(s)	Right
	Left
Accessories (Describe, if applicable)
TOTAL
Total maximum Cancellation Fee is lesser of 10% or $150 per hearing aid including accessories.

30 Day Money Back Guarantee: If a hearing aid is returned within 30 days of date of delivery in the same condition, ordinary wear and tear excluded, you are entitled to a refund of the portion of the purchase price of the hearing aid and accessories as itemized on the receipt and above, less the cancellation fee stated above. If a cancellation fee is imposed the nonrefundable amount for each aid and accessories cannot exceed 10% of the purchase price of the hearing aid and accessories or $150.00 per aid and accessories, whichever is less. You will, however, be responsible for all nonrefundable service fees listed in Part A. If you cancel your order prior to delivery, you are entitled to full refund of the purchase price of the aid and accessories, and a full refund for services not yet rendered.

Customer’s Signature	Date and time of Sale	DATE of DELIVERY
Registrant’s Signature	Registration No.	Customer’s Signature or Initials

(c) Additional responsibilities of registrant with respect to the disclosure agreement/money back guarantee.

(1) Before providing any services incidental to the possible sale of a hearing aid to the prospective hearing aid user, the registrant shall explain Part A of the disclosure agreement/money back guarantee to the prospective hearing aid user or authorized representative and shall complete Part A. The registrant shall also give a preliminary explanation of Part B, including any cancellation fees that may be retained if a purchaser decides to return a hearing aid. The registrant shall include in Part A a complete description of what the fitting procedure or process includes, and shall itemize and disclose fees associated with the fitting procedure or process and the sale and delivery of the hearing aid. For each service provided, the registrant shall identify by dollar amount the portion of the fee that is refundable and the portion that is not refundable. If a fee will be waived if a hearing aid is purchased, that shall be stated. If the registrant charges no fees for services, the registrant shall note that in Part A.

(2) After Parts A and B have been explained and Part A has been completed, the registrant shall have the prospective hearing aid user or authorized representative complete the time and date lines provided under Part A. The prospective hearing aid user or authorized representative and registrant shall also sign under Part A when appropriate.

(3) After completing the necessary testing, if it is determined that a hearing aid will be recommended, the registrant shall explain and complete Part B, itemizing any cancellation fee associated with the sale and delivery of a hearing aid and its accessories by designating that amount as ‘‘not refundable.’’ Part B shall be fully explained and completed before any payment is made. If Part B becomes inapplicable due to a decision by the registrant, prospective hearing aid user or authorized representative not to proceed further after testing, the disclosure agreement/money back guarantee need not be fully completed. The registrant shall provide a copy of the partially completed disclosure agreement/money back guarantee to the prospective hearing aid user or authorized representative.

(4) If the registrant and the prospective hearing aid user or authorized representative decide to proceed, the registrant shall explain the 30-day money back guarantee. If the prospective user or authorized representative decides to purchase a hearing aid, the registrant shall have the purchaser sign the second signature line on the disclosure agreement/money back guarantee and complete the line for date and time of sale, and shall also sign when appropriate.

(5) The registrant may revise the relevant portion of the disclosure agreement/money back guarantee form to disclose the registrant’s policy of offering a money back guarantee return period longer than 30 days. The money back guarantee shall be for at least 30 days from the date of delivery.

(6) After the disclosure agreement/money back guarantee is fully completed except for the date of delivery block and the hearing aid serial numbers, the registrant shall provide a copy of it to the hearing aid user or authorized representative.

(7) At the time the hearing aid is delivered to the hearing aid user or authorized representative, the registrant shall ensure that the signature or initials of the user or authorized representative is obtained and the date of delivery and serial number are inserted in the block or section provided for that purpose on the disclosure agreement/money back guarantee. After the block is completed with the initials or signature and date and the serial number is inserted, the registrant shall provide a copy of the completed disclosure agreement/money back guarantee to the purchaser.

(Editor’s Note: An Alternate Disclosure Agreement form was published at 42 Pa.B. 7061 (November 10, 2012).)

Notation

Cross References

This section cited in 28 Pa. Code § 25.214 (relating to recordkeeping).