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Nominate someone you know to receive the Gift of Hearing

The Hear Well Be Well Gift of Hearing program has supported communities in Ontario since 2014, delivering hearing aids, testing and services all at no charge to hundreds of people in need. Life can sometimes get in the way of doing what’s best for your health and we’re proud to be able to offer the Gift of Hearing program every year. See the 2022 recipients.

This year, thanks to the support of our friends at Beltone, we’re able to deliver the Gift of Hearing to even more Ontarians.

This year, Hear Well Be Well, in partnership with Beltone, are providing hearing aids, hearing assessment and service to five people free of charge as part of Hear Well Be Well’s Gift of Hearing program.

Complete all sections of the form below to nominate someone for the Gift of Hearing program. All nominations will be reviewed by an impartial panel who will select finalists based on a variety of criteria. Finalists will be notified by July 15, 2023 and given the next steps.

All nominees need to be 19 years of age or older, a resident of Ontario and able to attend, in person, one of the 13 Hear Well Be Well locations for their hearing assessment.

Download PDF version of Nomination Form

Nominator Information

Complete this section with your information if you’re the one doing the nominating.

Name(Required)

First Last

Organization

Email(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

Phone (Home)

Phone (Cell)

Relationship to the person you are nominating(Required)

Does the person know you are nominating them?(Required)

Yes

You understand all nominees will be considered however a limited number of nominees will receive the free hearing aids and service. You also understand the decision of the review panel is impartial and final.(Required)

Yes

Nominee Information

Complete this section with information about the person you are nominating.

Name(Required)

First Last

Email(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

Phone (Home)

Phone (Cell)

Is this person over 19 years of age?(Required)

Yes

Why do you think they need hearing aids?(Required)

Why do you think they need to receive the free hearing aids? What are their circumstances that require this kind of support?(Required)

Terms & conditions(Required)

I have read and accept the terms of conditions of eligibility as nominator. I understand any conditions that need to be met by the nominee will be reviewed with the nominee if they are selected to the short list and I have no responsibility for the nominee meeting the terms and conditions.

No purchase is necessary to nominate and no purchase will be required by the finalists or recipients of the free hearing aids and service.
Nominations must be received by June 1, 2023. Hear Well Be Well takes no responsibility for lost, misplaced or stolen nomination forms.
Nominee must be over 19 years of age.
Nominee must be resident of Ontario.
Nominee must be able to attend one of the Hear Well Be Well locations, in person, for hearing assessment. Check here for locations.
Finalists will be contacted between June 30, 2023 and July 15, 2023 by email or phone. Finalists will be screened according to the results of the hearing assessment.
The free hearing aid and service awarded to the recipients cannot be exchanged for cash.
To become a recipient of the free hearing aid and service:
1. Nominee must medically require hearing aids based on the comprehensive hearing test performed at a Hear Well Be Well location.
2. Nominee must be 19 years of age or older and be a resident of Ontario.
3. Nominee must medically require hearing aids based on the comprehensive hearing assessment completed at a Hear Well Be Well location.
4. Nominee must agree to attend all follow-up appointments to ensure they are adapting to and caring for their hearing aids as prescribed.
5. Nominee must agree to have their photograph taken and sign a release allowing Hear Well Be Well to share their hearing story in appropriate marketing and education materials pertaining to the charitable work done by the organization.
Hear Well Be Well reserves the right to terminate, suspend or modify this Program, in whole or in part, at any time and without notice or obligation, if, in Hear Well Be Well’s sole discretion, any factor or event arises that could interfere with the proper conduct, administration, security or impartiality of the Program as outlined in these Terms and Conditions. Without limiting the generality of the foregoing, if the Program, or any part of it, is not capable of running as planned for reason, including, but not limited to, infection by computer virus, tampering, unauthorized intervention, fraud, programming errors or technical failures, which corrupt or affect the administration, security, fairness, integrity or proper conduct of this Program, Hear Well Be Well may, in its sole discretion, void any suspect nominations and:
1. Terminate the Program, or any portion of it;
2. Modify or suspend the Program, or any portion of it, to address the impairment and then resume the Program, or the relevant portion, in a manner that best conforms to the spirit of these Terms and Conditions.
Hear Well Be Well reserves the right, at its sole discretion, to disqualify any individual who tampers or attempts to tamper with the nomination process, the operation of the Program, the Program website page, violates these Terms and Conditions, or acts with any intent to annoy, abuse, threaten or harass any person involved in the Program.
Limitation of Liability By participating in this Program, nominators, nominees, finalists and recipients agree Hear Well Be Well and its authorized agents have no liability whatsoever for, and shall be held harmless against any liability for injuries, losses or damages of any kind (including direct, indirect, incidental, consequential or punitive damages) to persons or property resulting from the Program, including the acceptance, possession, use or misuse of the hearing aids.
Protection of Personal Information Unless otherwise authorized, any personal information provided by the nominator, nominee, finalist or recipient when they participate in the Program, will be used only for the administration of the Program however all parties may give their express, opt-in consent to receive electronic messages from Hear Well Be Well. All personal information Hear Well Be Well or its authorized agents collect will be handled in accordance with the Hear Well Be Well privacy policy which may be found at: Privacy Policy.

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Name(Required)

First Last

Email(Required)

Phone(Required)

Location

Name

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I highly recommend this clinic, staff was fantastic!

I visited Hear Well Be Well in Meaford today for the first time. The staff were amazing, punctual and thorough. Mikela conducted a variety of tests and provided immediate feedback to my current hearing capability. I was delighted to learn my hearing is on par for a person of my age and no further investment was required. When I do require hearing aids, I will return to this clinic. I highly recommend this clinic, staff was fantastic!

Kevin Wright

Meaford Hearing Clinic

Nominate someone you know to receive the Gift of Hearing

Nominator Information

Nominee Information

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