Complete the Third Party Certification Form – 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.
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.
Return the signed form to CapTel by:
Note: Your doctor may be able to submit your form electronically on your behalf.
Fax the completed certification form to: 1-608-238-3008 or email to: Register@CapTel.com
Once we receive your signed certification form, we will contact you to arrange for free delivery and discuss the installation support options available.