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Get Hi A-fmhi-001 2015
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How to fill out the HI A-FMHI-001 online
This guide provides a detailed overview of how to fill out the HI A-FMHI-001 application form online for the CapTel service. Following these steps will help ensure accurate and efficient completion of your application.
Follow the steps to complete your application smoothly.
- Press the ‘Get Form’ button to access the application and open it in the editor.
- Begin filling out the form with your full name including last name, first name, and middle initial as prompted.
- Enter your shipping address. Ensure you do not use a P.O. Box for shipping.
- Provide your phone number and email address along with your age and age of onset hearing loss.
- Fill in your Social Security number and date of birth as required.
- Indicate your occupation, title, and place of work, as well as any organizations you are involved with.
- Indicate how you found out about the CapTel service by providing an answer in the designated space.
- Attach necessary documentation, such as a doctor's certificate or audiologist’s report, confirming your hearing loss.
- Answer the six liability and responsibility questions by checking ‘Yes’ or ‘No’ accordingly.
- Specify the degree of hearing loss and any technology you currently use.
- Indicate how you are currently communicating with hearing individuals on the telephone.
- Select where you will use the CapTel phone, whether at home or at work.
- Provide information regarding your current phone line and high-speed Internet availability.
- Choose the CapTel phone model you are interested in from the available options.
- Confirm whether you would like a free CapTel training session by selecting ‘Yes’ or ‘No’.
- Sign and date the application. If under 18, a parent or guardian's signature is required.
- Review all entries for accuracy before submitting.
- Once completed, save changes, and you may download, print, or share the form as needed.
Complete your HI A-FMHI-001 application online today to benefit from CapTel services.
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