Get Download The Certificate Of Hearing Loss/order Form

Filling out the Download The Certificate Of Hearing Loss/Order Form online is an essential step toward receiving your Hamilton CapTel phone at no cost. This comprehensive guide provides clear instructions to help you navigate the form efficiently and confidently.

Follow the steps to complete the form accurately online.

1. Click the ‘Get Form’ button to access the form and open it in your selected editor.
2. Begin with the applicant information section. You’ll need to provide your first name, middle initial (if applicable), and last name in the designated fields. Ensure that these details are accurate and well-printed.
3. Enter your address, including city, state, and zip code. This information is crucial for shipping your Hamilton CapTel phone.
4. Provide your telephone number and email address. The email will be used solely for order confirmation, so make sure it is entered correctly.
5. Indicate whether you have high-speed internet and telephone service where you will use the phone by selecting the appropriate option. If you do not have high-speed internet, please choose the alternative option to be contacted about other possibilities.
6. In the applicant certification section, read the statement carefully. Place your signature and date on the provided lines to confirm your understanding and agreement.
7. Proceed to the healthcare professional information section. Your healthcare professional must sign and certify the information regarding your hearing loss.
8. Ensure that all fields marked with an asterisk (*) are completed, as these are required for processing your request.
9. Once fully completed, save the changes. You may choose to download the form, print it for your records, and share it as needed.
10. Finally, submit the signed certification form through your preferred method: via email, fax, or mail, following the specific instructions provided.

Start filling out your Download The Certificate Of Hearing Loss/Order Form online today to ensure prompt service.