Certificate of Hearing Loss Order Form
Please complete the form below to submit a Certification of Hearing Loss/Order on behalf of your veteran/client.
Place Your Order
What happens when I submit my order?
Alternatively, you can download the form here as a PDF, then scan and email, or mail or fax it in (fax number and address are located on the form).
Feel free to contact Customer Care with any questions via email at info@HamiltonCapTel.com or by phone at (877) 455-4227.