Form - Ear Solutions

Question 1

Who needs the hearing aids?

Myself

My spouse / partner

My parent

Someone else

Question 2

Age of the hearing aid user?

Under 50

50–64

65–74

75+

Question 3

When do you struggle to hear the most?

Choose all that apply.

In conversations

Watching TV

In noisy places (restaurants, gatherings)

On phone calls

All of the above

Question 4

Do you currently wear hearing aids?

Yes, and I want to upgrade

Yes, but unhappy with them

No, this would be my first pair

Question 5

How do you plan to pay for your hearing aids?

Ear Solutions is a private-pay provider. We do not bill Medicare, Medicaid, or insurance directly.

Self-pay (credit/debit card, cash, HSA/FSA)

Monthly financing plan (0% APR available)

I have private insurance

Medicare / Medicare Advantage

Medicaid

VA / veterans benefits

Not sure yet

Just to confirm

We don't bill insurance directly. However, many of our customers pay out of pocket and then request out-of-network reimbursement from their insurer using the receipt we provide.

Would you be comfortable paying out of pocket for your hearing aids?

Yes, I can pay out of pocket

Yes, if financing is available

No, I only want what insurance covers

Just to confirm

Premium professionally-fitted hearing aids at Ear Solutions typically range from $2,000–$5,000 per pair, with 0% financing from $200/month. We do not accept Medicare, Medicaid, or insurance.

How would you like to proceed?

I'm ready to self-pay or finance

I'd like to discuss options on a call

I'm only looking for free / covered hearing aids

Almost there

Premium hearing aids range from $1,500–$5,000 per pair (financing from $200/month). Which fits you best?

I prefer to pay in full

Monthly financing works for me

I want to discuss pricing on the call

Actually, I'm looking for free/covered options

Last step

Where should we send your trial details?

Your contact info, so our team can reach you.

First name *

Last name *

Phone number *

Email *

ZIP code *

Preferred trial location?

At Home

At a Nearby Clinic

Tele-audiology

Best time to call you?

Morning

Afternoon

Evening

Thanks for your time.

Ear Solutions is a private-pay provider, so we're not able to bill insurance, Medicare, Medicaid, or VA benefits directly. Based on your answers, we're probably not the right fit for you right now — but we appreciate you taking the time to share this with us.

Phone number (optional)

If you'd still like a courtesy call to talk through options, leave your number.

Please fill in the highlighted fields to continue.

Check if You Qualify for a Home Trial