Download the Certificate of Hearing Loss/Order Form
If you have a patient with hearing loss that would benefit from Hamilton® CapTel®, it’s never been easier to order a no-cost1 Hamilton CapTel Phone. If you have any questions, please call 800-826-7111 or send e-mail to firstname.lastname@example.org.
Or provide your patient with a pre-printed form. If you’d like to order pre-printed forms, please call 800-826-7111.
Complete the form in its entirety. This requires your patient’s information and signature, as well as the signature of a Physician, Audiologist or Hearing Related Professional verifying your patient has a qualified hearing loss.
Submit the signed Certificate of Hearing Loss/Order Form as directed. Delivery typically takes 1-3 weeks.
Complete the Online Certificate of Hearing Loss/Order Form
1Independent third-party professional certification required.
Internet Protocol Captioned Telephone Service (IP CTS) is regulated and funded by the Federal Communications Commission (FCC) and is designed exclusively for individuals with hearing loss. To learn more, visit www.fcc.gov.
The Hamilton CapTel phone requires telephone service and high-speed Internet access. Wi-Fi capable.
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