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Contact Information for Loaner Program Administrator:
Minnesota Pediatric Hearing Device Loaner Program
c/o Children's Minnesota Audiology
2530 Chicago Ave S
Suite 450
Minneapolis, MN 55404
Phone: 612-813-7610
Secure Fax: 612-813-6889
Email: hearbank@childrensmn.org
User's Guide
Provider Account Request
- Download the provider account request form
- Fill out and email the provider account request form to hearbank@childrensmn.org
Hearing Device Agreement Form
Facility/Clinic Request
- Download the facility/clinic request form
- Fill out and email the facility/clinic request form to hearbank@childrensmn.org
Hearing Device Suggestion
- Download the hearing device suggestion form
- Fill out and email the hearing device suggestion form to hearbank@childrensmn.org