Contact Us Begin Our Hearing Aid Application Name Email Address Phone Number Mailing Address Do You Currently Have Health Insurance? Do You Currently Have Health Insurance?YesNo Please describe the nature of your current Health Insurance, if any Have you been a South Carolina resident for at least one year? Have you been a South Carolina resident for at least one year? YesNo What is your current annual income? How many persons currently live in your household? Have you had a hearing test within the last six months? * Have you had a hearing test within the last six months? *YesNo Submit Application *If you answer “no” to this question, please note that you must have a hearing test that is not more than six months old before you can apply.