Dc37 optical voucher request form 2026

1. Click ‘Get Form’ to open the dc37 optical voucher request form in the editor.
2. Begin by filling out the Employee Information section. Clearly print your last name, first name, and Social Security or Personal ID number. Include your address, phone numbers, department, job title, and date of employment.
3. Next, provide details about your spouse or domestic partner if applicable. Fill in their employer's name and insurance carrier.
4. In the Services section, check the boxes for the types of services you are claiming (e.g., eye examination, frames, lenses) and enter the corresponding charges.
5. Complete the Provider section by entering the examiner's and dispenser's names, addresses, telephone numbers, and dates of service.
6. Finally, review all entries for accuracy before signing and dating the form at the bottom.

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