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.

Hearing Services Program Application Form_cover image

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.

Hearing Services Program application form (effective from 1 July 2025)

This updated form must be used from 1 July 2025, however you can use this form sooner.

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.

About this resource

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

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