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For providers adding an additional Audiologist or Dispenser to your practice, please fill out the following form:
Add a provider to your Practice
To download a copy of the Provider Application, Click Here
Place of Employment
Name of School
I, the undersigned, understand that by not providing a copy of my degree / diploma with the HCS provider application, I am verbally verifying my degree is valid and that Hearing Care Solutions, Inc. may use this information for any credentialing needs. I attest this information is true and accurate to the best of my knowledge.
Print Full Name (Required)
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Check here if you accept these terms.