Certifying Agents

How to get your form certified.

In order to get approved for California Connect, Section 2 of your Application form must be certified by a qualified medical professional. Your current doctor, audiologist, or other medical professional can fill out Section 2 of the form.

Any costs required to get a certifying agent’s signature to participate in California Connect are the sole responsibility of the consumer. Costs might include, but are not limited to, transportation, doctor or certifying agent office visit fees, or parking.


Need to find a Certifying Agent?

If you do not have a doctor, you can search here to find a doctor or other medical professional in your area who can sign your Certification Form.

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