Get Hi A-fmhi-001 2017-2026

Filling out the HI A-FMHI-001 form online is an important step for individuals seeking access to the CapTel telephone service. This guide provides clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the HI A-FMHI-001 form online.

1. Click the ‘Get Form’ button to access the HI A-FMHI-001 form and open it for editing.
2. Begin by entering your full name in the designated fields, including last name, first name, and middle initial.
3. Provide your shipping address in the specified format; note that shipments cannot be made to P.O. Boxes.
4. Fill out your contact information, including home, work, and fax phone numbers, along with your email address.
5. Indicate the age of onset of your hearing loss and your date of birth in the required format.
6. Input your state ID or driver’s license number, including the state issued and expiration date.
7. Complete the occupation section by listing your title and place of work.
8. In the organizations section, note any relevant organizations you are involved with.
9. Indicate how you found out about the CapTel service by providing a brief description.
10. Ensure to attach a copy of your doctor’s certificate or audiologist’s report confirming hearing loss.
11. Answer the eligibility questions regarding the equipment rental, liability, and service responsibilities by selecting 'Yes' or 'No'.
12. Specify the degree of hearing loss, and any technology you currently use by selecting from the options.
13. List how you currently communicate with hearing individuals over the phone.
14. Indicate where you will use the CapTel phone and provide details about your phone line and Internet service.
15. If you have a preference, specify which CapTel phone model you are interested in.
16. Decide if you would like a free CapTel training session or phone installation and training.
17. Sign and date the application form, including a parent or guardian's signature if under 18.
18. Review completed fields for accuracy, then save any changes before downloading, printing, or sharing the form.

Start completing your HI A-FMHI-001 form online today for access to essential communication services.