Step 1: Do You Qualify?
Step 2: 5 Minute Hearing Test
Step 3: Choose Device
Step 4: Complete Form
Thank You

Do you (or someone you know) qualify for a FREE phone?

Let's find out! Please answer the following questions

5 Minute Hearing Test

I have a problem hearing over the telephone

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

I have trouble following the conversation when two or more people are talking at the same time

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

People complain that I turn the TV volume too high

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

I have to strain to understand conversations

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

I miss hearing some common sounds like the phone or the doorbell ringing

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

I have trouble hearing conversations in a noisy background such as a party

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

I get confused about where sounds come from

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

I misunderstand some words in a sentence and need to ask people to repeat themselves

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

I especially have trouble understanding the speech of women and children

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

I have worked in noisy environments (assembly lines, jackhammers, jet engines, etc.)

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

I hear fine – if people just speak clearly

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

People get annoyed because I misunderstand what they say

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

I misunderstand what others are saying and make inappropriate responses

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

I avoid social activities because I cannot hear well and fear I will make improper replies

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

A family member or friend has suggested that maybe I have a hearing problem

-- Please choose one --

Never

Occasionally

Half the time

Almost Always

Total Points: 0

Note: If you scored 10 or more points, you should have your hearing tested

Choose Your Phone

-- Please choose one --

Clarity Desktop Duo Amplified Telephone with Expansion Handset

Clarity Caption Telephone (XLC8GLT Deluxe)

XLC8 Combo Pack (XLC8 & XLCGo)

XLC8 Combo Pack (XLC8 & XLCGo) with Extra Handset

XLC8 Cordless Amplified Phone

XLC8 Cordless Amplified Phone with Extra Handset

XLCGo Smart Phone Amplifier

ALTO PLUS Corded Amplified Phone

SA-40 Smart Phone Amplifier

XLC7BT Cordless Amplified Telephone

Alto Amplified Telephone

CSC500 Amplified Telephone

CSC600 UltraClear Amplifying Speakerphone

HD-40S Speech Amplified Telephone

CR200 Audio and Visual Ringer

TR75 Visual Ringer

425 TTY

4400 TTY

CapTel 840 Plus

Boom Mic Headset Amplifier

In-line Headset Amplifier

EarBud Headset Amplifier

UA-50 In-Line Amplifier

SquareGlow Flasher

Do you have a landline phone?

Yes

Do you have a cell phone?

Yes

Language

-- Please choose one --

English

ASL/Signed Language

I am:

-- Please choose one --

Deaf

Deaf-Blind (dual sensory impaired)

Hard of Hearing

Speech Impaired or having a speech impairment

Birth Date *

First Name

Last Name

Phone Number

In the box below, please enter the primary Email Address you would like to use for your application. This can be your email or the email of a person assisting you with the application process (e.g. family member). This email will be used for important updates during the application process, including requesting additional action and/or information from you. Be sure to periodically check your email, including SPAM/Junk folders, for any emails from outreach@ftri.org.

Primary Email for Important Updates

Street Address

City in Florida

Zip Code

Alternate Contact Name

Alternate Contact Relationship

Alternate Contact Phone

Alternate Contact Email

How did you hear about us?

-- Please choose one --

Friend / Family

Other

Digital Ad / Social Media / Internet / Facebook

Doctor / Hearing Aid Provider / Medical Staff

FTRI Event / FTRI Presentation

FTRI Website / RDC Website

Newspaper Ad / Direct Mail Ad / FTRI Flyer / Coupon

TV / Streaming Video Ad

Do you wear hearing aids?

Yes

Florida Residency Identification Type?

Florida Driver's License

Voter ID

State ID

Residency Identification Number

IMPORTANT

Please re-check your email address above, to make sure you entered correctly. You will be receiving a confirmation receipt via email if your application is approved. For security and privacy, you cannot make changes after you submit this application. If you need to update your email after submission, you must contact our customer care department by phone or use our instant chat feature to request the change.

Continue

Welcome to the FTRI Equipment Program Application

Here's what you will need to complete the process online:

• Your basic information, including your address (and shipping address), and alternate contact person's name and information.
• A Photo or a Scan of one of the following (to show proof of residency):
- ◦ Driver's License
- ◦ State ID
- ◦ Voter ID

It's easy to apply, in Four Steps:

• Answer four qualifying questions about Florida residency, and communication needs.
• Answer the Five Minute Hearing Test questions, to determine your level of hearing loss.
• Choose the equipment you would like to receive.
• Complete the application form.

Once you click on the "Get My Free Phone" button at the bottom of the Step 4 Application Form page, you'll be taken to the Thank You page, where you can upload your documents.