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 877-662-4144 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 877-662-4144.
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.
FEDERAL LAW PROHIBITS ANYONE BUT REGISTERED USERS WITH HEARING LOSS FROM USING INTERNET PROTOCOL (IP) CAPTIONED TELEPHONES WITH THE CAPTIONS TURNED ON. IP Captioned Telephone Service may use a live operator. The operator generates captions of what the other party to the call says. These captions are then sent to your phone. There is a cost for each minute of captions generated, paid from a federally administered fund. To learn more, visit www.fcc.gov.
Third-party charges may apply: the Hamilton CapTel phone requires telephone service and high-speed Internet access. Wi-Fi capable.