CapTel application form for onine indd 2026

1. Click ‘Get Form’ to open the capTel application form in our editor.
2. Begin by entering your Full Name, including Last Name, First Name, and Middle Initial in the designated fields.
3. Fill out your Shipping Address accurately, ensuring it cannot be a P.O. Box. Include Street Name, Apt. # (if applicable), City, State, and Zip Code.
4. Provide your Phone Number and Email address. Additionally, indicate your Age of Onset Hearing Loss and Date of Birth.
5. Complete the section regarding your State ID or Driver’s License number along with its expiration date.
6. Answer questions about your occupation and organizations you are involved with. This helps us understand your background better.
7. Indicate how you found out about the CapTel Service in the specified field.
8. Ensure you check the box confirming whether you have enclosed a doctor’s certificate or audiologist’s report indicating your hearing loss.
9. Review all statements regarding liability and responsibilities carefully before signing at the bottom of the form.

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