Hearing Services Program application form

Use this form to apply for the Hearing Services Program if you can’t apply online or through a provider.

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Hearing Services Program application form

To send us this form by fax or post, download the PDF to your computer, then complete the form, print and send. You can print a blank form and fill it in by hand if you prefer, then send.

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Publication date:
Publication type:
Form
Audience:
General public
Language:
English
Description:

There are 3 ways to apply for the Hearing Services Program. You can apply:

  • online
  • through a hearing services provider
  • by completing this form and sending it to us.

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If you would like a response please use the enquiries form instead.