Fill out the first section of the application, print, and sign.
Get the application certified. In addition to
your doctor, any of the following may
certify your need and sign the application
form for you:
Licensed Medical Doctor (MD)
Licensed Physician Assistant
Licensed Nurse Practitioner
Department of Rehabilitation Counselor
Licensed Speech-Language Pathologist
Superintendent/Audiologist from the California School for the Deaf Fremont/Riverside
Licensed Hearing Aid Dispenser
If you don't have one of these available, we can help. Just click Certifying Agent and we'll help you find one.
Once your form has been completed and signed by a Certifying Agent, you can take it to a Service Center near you to get your new phone equipment, or mail or fax your form to our Contact Center.
If you decide to mail or fax your form to the Contact Center, you will receive your approval by mail within about one week. You then need to call the Contact Center at 1-800-806-1191 to discuss what is the best phone for you.
Monday - Friday
8:00 AM - 6:00 PM
Please note that the phone number and work hours listed above are for the Call Center and not the actual Service Centers.