The Speech and Hearing Center has a limited budget to help you receive the speech and hearing services that you need. We must be considered, however, a payer of last resort.
- This offer is limited to Illinois residents of Cook, DuPage, Will, and Grundy Counties seeking services or products from The Speech and Hearing Center.
- To determine your eligibility for services assistance, it is important to follow the steps described below.
Step 1 - Seek Out Addtional Help
Your first step is to contact the organizations listed below for financial support.
- Your insurance provider. Do they cover testing or hearing instruments? Please let us know the extent of the coverage that they will provide.
- Patients from birth to 3 years of age, contact Child and Family Connections —
1-888-594-8364. To visit their website, click here.
- Patients from birth to 18 years of age, contact the Division of Specialized Care for Children
- Chicago South Regional Office: 312-433-4100
- South Cook Regional Office: 708-482-0633
- DuPage Regional Office: 630-964-9887
- To visit their website, click here.
- Patients older than 18, contact the Illinois Department of Human Services —
1- 800-843-6154 or, to visit their website, click here.
- Veterans, contact your local VA office. For the VA's website and facility locator, click here.
If you're denied support by these organizations, proceed to Step 2 below.
Step 2 - Download Application
If you're denied support by the organizations listed in Step 1, only then fill out our application for professional-services assistance.
To download this PDF document visit our Downloads page and click, Professional Services Assistance Application Form 12-2013.pdf.
- Note: To read, fill out on line, and print a PDF document, you need Adobe Reader installed on your computer.
- If you need a copy of this software, you can download a free copy by clicking here.
Be sure to collect all the required, supporting evidence. If you have any problem downloading this application, you're welcome to pick up a copy at one of our three locations.
If you have any questions or need further assistance with any aspect of our application, please email Pat Mulcahy or call her at 708-599-9500.
Step 3 - Submit Your Application
- After downloading the application, fill it out using your computer (no need to print it first)
- After completing the application, save the file with your last name in the file name
(e.g., Smith Professional Services Assistance Application Form 12-2013.pdf)
- Attach the file that you saved to an email and send it to firstname.lastname@example.org
- Fill out the application on your computer (print it after completing it) or print it first and fill it out by hand
- Mail your completed application with all the supporting evidence required to the following address:
The Sertoma Speech and Hearing Center
Professional-Services Assistance Application
10409 S Roberts Rd
Palos Hills IL 60465
We will review your application carefully and contact you regarding your eligibility.