Board of Examiners for Hearing Instrument Specialists

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Change of Address

Please provide the Missouri Board of Examiners for Hearing Instrument Specialists with any change in your home address, phone #'s or email address. Please use the form below to report changes and click submit.

To change only your phone #'s or email address, please click on the changed information.

Name as it appears on the certificate
Last Name:
First Name:
Middle Initial:
License #:
Current Address
Please indicate whether this is a home or business address that is being changed. * Required Home
Business
Current Street:
Current City:
Current State:
Current Zip Code:
Current Telephone Number:
Current Email: