OTC Hearing Aids and "Prescription" Hearing Aids Resource Page view page

SLP-Assistant Registration Renewal

Assistant Renewal Online Form

"*" indicates required fields

Step 1 of 3

Cost: $40.00 (+$3 for PayPal)

By Signing I Certify that I, the supervising licensee for this registrant is completing this form as required by Article 22.
Clear Signature

Assistant Information

Name*
Address*