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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
555 Walnut St.
7th Floor, Suite 701
Harrisburg, PA 17101

 
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 717-783-3188 .
 
Just a reminder that all fitter renewals or reinstatements must include proof or attestation of completed current Continuing Education Credits (CEU's).
 
Dealer registration application must include a copy of your current Pennsylvania Audiologist License, Physician License, or Fitter Registration.  All dealerships must file appropriate business documentation, including fictitious names with the Department of State.

All apprentice registrations must include a Training and Education Form signed by the sponsor and government criminal background check.
 
Temporary Fitter registration form must include a copy of your current license or registration held within another state, statement from licensing/registration agency that it has been held at least 2 out of the last 5 years and in good standing, and finally government criminal background check.