JOIN HearPeer

To join the HearPeers program, please provide the following information:

CI recipient's first name

CI recipient's last name

Parent's first name
(if CI recipient is a child)

E-mail address

State / Country

Date of birth of CI recipient

Gender of CI recipient

female

male

Cause of deafness

Pre- or post-lingually deaf

pre-lingual

post-lingual

Date of MED-EL implantation

Bilaterally implanted

yes

CI recipient's story

Please share some background information on your hearing loss and cochlear implant experience. You can enter text here directly or copy and paste from another application.

Your personal homepage (optional)

Disclaimer / HIPPA Information:

Applicants First name

Applicants Last name

I've read the disclaimer and HIPPA Information and accept all terms and conditions

Version: 1.2