Skip to Main Content
Portal Login
{}
Search Hearing Services Online
For Everyone
For Professionals
About the Program
Text size:
A
. Default text size
A
. Large text size
A
. Very large text size
How can the program help me?
Sub-pages of How can the program help me?
Am I eligible to receive fully subsidised hearing services?
I'm eligible-how do I apply?
I've applied-what happens next?
Client Information
Sub-pages of Client Information
Hearing services available
Hearing device information
Veteran Specific
About Hearing
NDIS
Factsheets and Forms
Sub-pages of Factsheets and Forms
Factsheets about the program
Hearing services factsheets
Hearing device factsheets
Home
>
Web Form
Z7_KQ561I02KO0350AQ097IO610I3
Online enquiry and feedback form
If you would like to make an online enquiry or provide feedback please use the form below.
Who are you?
Client
Service Provider
Device Manufacturer
Other
First name
Last name
Email
What is your feedback regarding?
Service Provider
the Hearing Services Program
the Call Centre
the website
Device Manufacturer
Other
Please provide details
If applicable what is your desired/ideal outcome?
If you are a client of the program please provide the following information
Eligibility Type
Pensioner Concession Card
DVA Gold Card - issued for all conditions
DVA White Card - issued for hearing loss
Sickness Allowance from Centrelink
Dependent of someone with one of the above concessions
Current serving member of the Australian Defence Force
DES (Disability Employment Services) participant
NDIS (National Disability Insurance Scheme) participant
CSO (Community Service Obligation) client
Eligibility Number
Date of Birth
Consent
Your personal information is protected by law, including the Privacy Act 1988, and is being collected by the Australian Government Department of Health (the Department) for the purposes of determining eligibility for and administering the Hearing Services Program.
If you do not provide this information then the Department will not be able to provide you with hearing services under the program.
You can get more information about the way in which the Department will manage your personal information, including our privacy policy at
www.hearingservices.gov.au
.
By consenting to this form you are authorising the Department to collect, store and disclose your information, including personal information.
Do you consent
Yes
No
Thank you for taking the time to provide feedback. Please click submit to send us your feedback.
Complementary Content
