Nominate a Veteran

Tinnitus is the number one service-related condition among US veterans.  An often overlooked 'souvenir' from active duty, it’s typically a result of exposure to loud noise.  

If you are a current Levo System provider and you would like to nominate a veteran to receive a complimentary Levo Patient System, please complete this form.

Provider Name *
Provider Name
Veteran Name *
Veteran Name