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

Hamilton® CapTel®
Or switch your phone to one of these other options
Hamilton® CapTel® 880i
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Hamilton® CapTel® 840i
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Hamilton® CapTel® 2400i
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Hamilton® CapTel® 880i
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Hamilton® CapTel® 2400i
Choose This Phone
Hamilton® CapTel® 840i
Choose This Phone

What happens when I submit my order?

Please enter a valid First Name
Please enter a valid Last Name
Select your military branch
Please check your Street Address
Please enter a valid City
Select your State
Please enter a valid ZIP Code
Please enter a valid Phone Number
Please enter a valid Phone Number
Please enter a valid Phone Number
Please enter a Service
NOTE:

High-speed internet can be Wi-Fi or Ethernet cable

Alternative Contact Information
Please enter a valid First Name
Please enter a valid Last Name
Please enter a valid Email Address
Please enter a valid Phone Number
Submit Your Order

Required field

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.