Facilities, Providers & Managed Care Plans > Hearing Aids > Hearing Aid Registration Program - Forms

 Hearing Aid Registration Program - Forms 

 
Please submit your payment, completed form(s), and supporting documentation to our office:
 
      Pennsylvania Department of Health
      Hearing Aid Program
      132 Kline Plaza, Suite A
      Harrisburg, PA 17104-1579
 
If you are paying by a major credit card, you may fax your completed form(s) and supporting documents (if necessary) to our office at (717) 772-0232.
 
Just a reminder that all Fitter renewals or reinstatements must include proof of Continuing Education Credits (CEU's).
 
Dealer registrations must include a copy of your current Pennsylvania Audiologist License, Physician License, or Fitter Registration.
 
All apprentice registrations must include a Training and Education Form signed by the sponsor.
 
Temporary Fitter registration form must include a copy of your current license or registration held within another state.
 
Click the tab on the left side navigation bar to see our FAQ page for fee and additional information, or contact us at (717) 783-8078. 
 
Note: All of the files listed above are in PDF format and require the free Adobe Acrobat Reader to be installed on your computer in order to access, view, and/or print copies of the files.  Please click here to learn more about Adobe Acrobat Reader.