Luv Your Ears - About - Luv Your Ears Foundation

Recipient Application:

If you or a loved one is in need of a hearing aid, please fill out the application form below.
Please note: The submission of this application does not guarantee acceptance onto our waiting list. Successful applicants may be subject to a face to face interview and credit check before receiving a hearing aid.

* Indicates required field

Full name *

Applying on behalf of *

Contact Number *

Email Address *

If you are applying on behalf of someone else, please note the following questions are applicable to the recipient only:

Age *

Gender *

Citizenship Status *

Province of residence *

City / Town of Residence *

Employment Status *

Have you been diagnosed with hearing loss by an audiologist *

If so, how long ago were you diagnosed *

Do you currently own any form of hearing aid or PSAP *

If so, please describe the current condition of your hearing device *

Submit