The Hearing and Speech Foundation is a non-profit charitable organization assisting people with hearing and speech related services. Individuals who cannot afford the cost of these services are provided services as long as funding is available and they meet the Foundation requirements. Applicants must submit a completed application along with required supporting documentation before the application is reviewed.

Completed applications are reviewed as received. Services may be delayed if we have to call you about missing documents. If you need assistance completing this application or do not understand a question, then please call the office at (865) 977.0981 and we will be happy to assist you.

Once your application is reviewed, our office will send a letter of your patient status with the Foundation. It is at this time, if approved, you will be eligible as a Foundation patient. The waitlist for services as of January 2010 is six (6) to nine (9) months.

The following information must be included with this application: 

1. Verification of residency (no post office boxes—we must have a street address) you may submit an item such as a bill with street address (utility, cable, or phone bill) or a copy of your driver’s license if the address is correct.
2. Proof of household income – you may submit a Social Security statement (and/or SSI), an alimony statement, VA benefits statement, retirement pension statement, disability income statement, income tax return or a check stub from your employer.
3. Financial Information – Please also include copies of your bank statement for the past three (3) months for expense and income verification. If you filed taxes, please include the income tax return.
4. Copies of medical health insurance card(s)—front and back
5. Your doctor’s name, phone number and fax number. We must have a referral for your visit to our clinic and if we do not have your doctor’s contact information, acceptance as a patient may be delayed. If you can get a written referral from your doctor on your own it will speed the process up considerably.

Click here to download an application. Please note, the application requires Adobe Reader. If you do not have Adobe Reader, you can download a free version here.