Receive a No-Cost Phone with Certification
Individuals with hearing loss may receive an Internet-based CapTel phone at no cost with a signed Certification Form from a qualified hearing healthcare professional, such as a doctor or audiologist.
Not able to visit your doctor’s office? No worries.
You can fill out the form and provide it to your doctor – either by email, by fax, or via U.S. Mail. Many offices can even certify your form electronically. You do not need to schedule an office visit to receive certification.
No Cost Phone Through Your Audiologist
Step 1: Complete Form
Complete the Professional Certification – by filling it out online or downloading the file and then saving it to send electronically, or by printing the form out to complete it in writing.
Step 2: Certify Form
Have the form signed & dated by a hearing professional as listed below. You can email, fax, or mail the completed form to your doctor for signature. Check with your doctor’s office for the correct contact information.
Step 3: Submit Form
Return the signed form to CapTel by:
- Fax: 1-608-238-3008
- Email: email@example.com
- U.S. Mail: 450 Science Drive, Madison, WI 53711
- Local Outreach Educator: Find Local Outreach Educator
- Your doctor may be able to submit your form electronically on your behalf.
Once we receive your signed certification form, we will contact you to arrange for free delivery and discuss the installation support options available.
Professionals qualified to sign the Certification Form:
- Doctors (with a hearing-related specialty)
- Primary Physician
- General Practice Physician
- Ear Nose Throat (ENT) Doctor
- Geriatric Practice
- Hearing Related Professionals
- Hearing Instrument Specialists
- Veterans Service Officer
- Speech Language Pathologist
- Social Worker