Australian Government - Department of Health - Office of Hearing Services
Hearing Services Program

Forms and publications for clients and professionals

This page includes a range of forms and publications relating to Australian Government Hearing Services Program (the program) for professionals, clients, and eligible people.

Forms for clients

Medical certificate form

If you are a new client to the program, this form must be completed by your medical practitioner. Once complete please take it to your hearing services provider to finalise your application.

Medical Certificate Form (PDF)
Medical Certificate Form (Word)

Client application form

You can apply for the program online.  In most cases your online application will take a few minutes to complete and you will be told if you are eligible once you have submitted your application.  If you are eligible, you will be sent a welcome pack to the program, and a medical certificate to take to your service provider. 

Apply online today

If you are unable to apply online you can apply by

  • visiting a service provider who can help you apply for the program
  • downloading the paper application form below, to print out and complete

Client Voucher Application Form (PDF)
Client Voucher Application Form (Word)

Reconsideration and appeals form

People who are affected by and dissatisfied with certain decisions made by the program are able to request a reconsideration. A request for reconsideration can only be made in very specific circumstances. You can find more information about reconsideration requests on our website.

Reconsideration and Appeals Form (PDF)
Reconsideration and Appeals Form (Word)

Publications for clients

Hearing Services Program factsheet

The Hearing Services Program factsheet provides information on eligibility, applying for the program and how to find a service provider.

Client Information Booklet

The information booklet outlines the services that are available to eligible clients.

Forms for professionals

Minimum Hearing Loss Threshold

The MHLT is a set of criteria that must be met before fitting or refitting hearing devices. For clients with a 3FAHL of less than or equal to 23db the Wishes and Needs Tool (WANT) questionnaire should be completed. Service providers should document the information and retain it on the clients file.

Eligibility Criteria for Refitting

Service providers should exercise their clinical judgment when making decisions about refitting. Service providers are required to fully document the reasons for refitting and retain this on the clients file. Frequently asked questions have been prepared to assist service providers on the Eligibility Criteria for Refitting.

Request for new voucher when existing has not expired

If a clients' hearing or health changes significantly after they have received the full entitlement of their current voucher (i.e. they have been assessed, received a hearing device and /or rehabilitation), then you are able to request a new voucher before the existing one expires. Please submit the completed request to hearing@health.gov.au.

Please note that a request for new voucher when existing voucher has not expired may take up to 15 business days to be processed.
Request for New Voucher when existing Voucher has not yet expired (PDF 76 KB)
Request for New Voucher when existing Voucher has not yet expired (Word 505 KB)

Manual Claim for Payment Form

The manual claim for payment form is used when you are unable to make an e-claim or a claim through the portal. 
Manual Claim for Payment fillable form (PDF 116 KB)
Manual Claim for Payment form (Word 58 KB)
Battery and Maintenance Claim for Payment fillable form (PDF 124 KB)
Battery and Maintenance Claim for Payment form (Word 68 KB)

Non-Scheduled Device Request Form

This form is to be used when seeking approval to fit a client with a hearing device that is not listed on the schedule of devices.
Request to Fit a Non-Scheduled Device (PDF)
Request to Fit a Non-Scheduled Device (Word)

Statutory Declaration for Replacing Lost Aids

If the client has lost their hearing device, they will need to complete a statutory declaration form, which must be retained on the clients file. A statutory declaration form and further information is available on the Attorney-General's website.  Further information is available on replacing a lost or damaged device.

Clients Rights and Responsibilities poster

The Client Rights and Responsibilities poster outlines the clients’ rights to be treated with respect, to be informed about treatment options, to be given a choice of hearing devices from fully subsidised or partially subsidised devices and privacy issues. It also outlines clients’ responsibilities to disclose relevant medical information, respect staff and participate in follow up care.

Clients Rights and Responsibilities Poster

The contracted service provider contract requires that the poster be displayed at each Permanent Site. There is an online ordering facility for posters.

 




Hearing Services Program contacts

Legislation and contracts

For professionals

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