- Application must be completed and signed by the applicant.
- Financial information must be listed for each person in the dwelling in which the applicant resides.
- Physician's prescription is required for all items needed.
- If total cost of items is $200 or less, only one (1) price quote is required.
- If total cost of items is over $200, two (2) price quotes are required.
- Hearing aids require only one price quote.
- If there are extenuating circumstances, a short letter may be included but is not required.
- Mail or fax application, prescription, and quote(s) to address or fax number listed at bottom of application.