Panasonic WH-R17C Operating Instructions Manual page 58

Information
For your reference
Name of owner:
Hearing instrument dispenser:
Dispenser address:
Dispenser phone:
Purchase date:
Hearing instrument model number:
Hearing instrument serial number*:
Receiver model number:
Receiver serial number*:
*The serial number is printed on the package label.
58
(Continued)
(Fill out when you purchase your hearing aid)