Download Patient Applications
Download the AUDIENT Program Application
(PDF | 63.7 KB)
If you are unable to download the application, please call: 1-866-956-5400 x2 to request a copy.
If you are unable to afford the reduced cost of the hearing aids through the AUDIENT program, it may be helpful to seek additional financial support for purchasing the aids through a low-interest rate Assistive Technology loan. The types of loans offered varies by state. You can find information for your state by visiting http://www.resnaprojects.org/AFTAP/state/RESNA.html.
Updated June 12, 2013