If you are in our coverage area you may apply for assistance, print the application and instruction letter.The Audiologist and the Medical Doctor will require your insurance card and ID. You are responsible for any deductible or co-pay your insurance requires. You should discuss this with the Audiologist prior to your visit. Make certain that the testing audiologist will use an instrument supplied by the Lions Hearing Aid Bank. if you are approved. It may take up to 2 weeks to get approval. and several weeks after that before the instrument is ready to go to the Audiologist for your fitting.
Please note: As of May 1, 2023 an application fee is required to file. The non-refundable fee of $50 for one instrument and $100 for two instruments. Do not submit the application
without the fee.
New Phone number -804-248-9938
If you are not in our coverage area do not use this form.