Please submit this form in the following scenarios:

• New hearing aid(s) fittings
• Hearing aid(s) replacements
• Hearing aid(s) exchanges

On your attached real ear measure (REM) tracings, include:

• Worker's name and WorkSafeBC claim number
• Labelled targets and input levels
• Hearing aid serial number(s)

Note that Form 83D72 is not required when requesting hearing aid(s) replacements, however, you must attach current real ear measure (REM) tracings for the hearing aids being requested for replacement.

Upload the form

When you’re ready to submit the form, please ensure you’ve provided all of the required information and then send it to us using our claims document uploader.