E-Funding

Welcome To EyeTech’s E-Funding Page

We’re here to work with you and your provider to expedite the funding process. For those living in the United States, you can securely complete and submit the funding packet for a new EyeTech device below.

Forms

Client Information Form

Must be signed by Client, Guardian or SLP. Copies of insurance can be uploaded through this form.

Assignment of Benefits

Must be signed by Client, or Guardian if under 18 and witnessed by someone.

RX Form

Can be filled out by Rep, SLP and then emailed to the Doctor for signature.

Speech Evaluation Form

Must be completed and signed by the SLP or upload your own HERE

Letter of Medical Necessity

Can be filled out by Rep or SLP and then emailed to the doctor for signature

Face to Face Notes

Email the link to complete directly to the Doctor's office.

Just getting started on your AAC device journey? Visit our funding page below for more information about who to consult, steps of choosing your device, getting funded, and receiving your EyeTech device.