The CaptionCall professional certification form is a one-page document a qualified professional signs to confirm you have hearing loss that requires captioned telephone service. You fill in your contact details and product preference at the top, your certifying professional completes and signs the bottom, and you return it to CaptionCall by email, fax, or mail. You can get the form from a CaptionCall field representative, download it from Sorenson’s website, or ask your hearing professional to request one directly.
Who Can Sign It
The pool of qualified signers is wider than most people assume. Under FCC rules at 47 CFR ยง 64.604(c)(9), the certifying professional must be qualified to evaluate hearing loss under applicable professional standards. The regulation names audiologists, speech-language pathologists, hearing instrument specialists, doctors, nurses, and other medical or health professionals, and it also includes vocational rehabilitation counselors, occupational therapists, social workers, educators, and community-based social service providers.1Federal Register. Misuse of Internet Protocol (IP) Captioned Telephone Service
The form itself narrows that list to 14 checkbox specialties: Audiologist, ENT, Family Physician, General Practice, Geriatrician, Gerontologist, Hearing Instrument Specialist, Veteran Service Officer, Internal Medicine, Pediatrician, Speech-Language Pathologist, Physician Assistant, Otolaryngologist, or Nurse Practitioner.2Sorenson. CaptionCall Professional Certification Form If your provider’s specialty is covered by the FCC rule but doesn’t match any checkbox, call CaptionCall before submitting to confirm they’ll accept it.
One independence rule matters: the certifier cannot have been referred to you by any IP CTS provider, and they cannot have a business, family, or social relationship with the provider delivering your service.1Federal Register. Misuse of Internet Protocol (IP) Captioned Telephone Service Your regular audiologist or primary care doctor will almost always qualify.
Filling Out Your Half of the Form
The patient section at the top asks for your name, street address, city, state, zip code, phone number, and email. If you already have a CaptionCall account number from an earlier contact, enter it; if not, leave that field blank.2Sorenson. CaptionCall Professional Certification Form The phone number should be the ten-digit number you intend to use with the service.
Separately, to meet the FCC’s IP CTS registration database requirements, CaptionCall will also collect your date of birth and the last four digits of your Social Security number or Tribal Identification number. If you have neither, you can submit alternative identification such as a current driver’s license, state ID, birth certificate, or passport, together with a document showing a U.S. address.3Federal Communications Commission. New IP CTS Registration Requirements FAQs
What the Certifying Professional Fills In
The healthcare provider section asks for the professional’s name, title, practice or business name, full practice address, phone number, and email.2Sorenson. CaptionCall Professional Certification Form They check the box for their specialty, then sign and date.
By signing, the professional certifies in writing that you have hearing loss necessitating captioned telephone service and that they understand captions are produced by a live communications assistant funded through a federal program.1Federal Register. Misuse of Internet Protocol (IP) Captioned Telephone Service The certification is made under penalty of perjury. Coordinate with the signer before mailing anything, because both halves need to be complete when the form arrives.
Product and Language Choice
At the bottom of the form, pick whether you want the CaptionCall home phone, the mobile app, or both, and choose English or Spanish captions.2Sorenson. CaptionCall Professional Certification Form The mobile app runs over Wi-Fi or cellular data on a device you already own; the home phone uses your home internet and phone line.
How to Send It In
Once the form is signed, you have three ways to submit it:
- Email a scan or clear photo to certification@captioncall.com
- Fax it to 1-888-531-1906
- Mail it to CaptionCall Outreach, 4215 S Riverboat Rd, Salt Lake City, UT 84123
Email is the fastest route and avoids problems from faint handwriting or fax quality.4Sorenson. CaptionCall Professional Certification Form Check that every field is filled in and the signature is legible before you send; a missing signature or blank field is the most common reason CaptionCall asks for a resubmission.
If You’d Rather Self-Certify
Professional certification is not strictly required by federal rule. Under FCC rules effective August 28, 2014, new IP CTS users may register by self-certifying that they have hearing loss necessitating captioned telephone service, that they understand captions are provided by a live communications assistant, and that each captioned call is funded through a federal program.5Federal Communications Commission. Effective Date of IP CTS Registration and Certification Rules
Even so, some providers, CaptionCall included, may still ask for a signed professional form before activating service.6U.S. Department of Veterans Affairs. Free Captioned Telephone Service for Those With Hearing Loss If you already have documentation (an audiogram, hearing aid fitting records, or a VA audiology report), a professional can usually sign the form during a routine appointment at no extra charge.
After You Submit
Once CaptionCall processes the form and verifies the professional’s credentials, you’ll get confirmation that your account is active. The company forwards your registration details to the FCC’s IP CTS User Database, and you’ll be asked to give explicit permission for that data submission.3Federal Communications Commission. New IP CTS Registration Requirements FAQs If you asked for the home phone, a technician will schedule installation and show you how to use it. If you chose the mobile app, you can download it and sign in once your account is confirmed.
If anything is off, a missing signature, an illegible field, or a specialty that doesn’t match a checkbox, CaptionCall will contact you to request a corrected form. Keep a copy of the completed form for your records in case you switch providers or need to re-register later.