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Audiologist Recommended

Receive a No-Cost Phone with Certification

Professional 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

Third Party Certification of Eligibility for IP CapTel Services - No Cost CapTel - free phone
Certification Form

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:

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:

  • Audiologists
  • Doctors (with a hearing-related specialty)
  • Primary Physician
  • General Practice Physician
  • Ear Nose Throat (ENT) Doctor
  • Geriatric Practice
  • Nurse
  • Hearing Related Professionals
  • Hearing Instrument Specialists
  • Veterans Service Officer
  • Speech Language Pathologist
  • Social Worker