For providers adding an additional Audiologist or Dispenser to your practice, please fill out the following form:
Add a provider to your Practice
Please fill in all of the fields. Do not close the window, otherwise your progress will be lost. This application will have THREE sections and an Agreement section. Each section must be submitted before continuing to the next. As soon as you submit one section you will not be able to go back. If you would like the printable application please click here.