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Click ‘Get Form’ to open the VISION FORM - 20/20 Vision Care in the editor.
Begin by entering the Group or Employer name, followed by the Plan Member’s Full Name, Group Number, and Date of Birth. Ensure accuracy as this information is crucial for processing your claim.
Fill in the Plan Member’s Address, including Street, City, Province, and Postal Code. Don’t forget to provide a contact phone number for any follow-up inquiries.
Indicate your Language Preference by selecting either English or French.
If claiming for dependents, complete their details including Date of Birth and Relationship to Plan Member. If applicable, provide the most recent date of full-time student registration.
In the DETAILS OF THE PRESCRIPTION section, specify whether it is a new prescription or an initial one. Fill in all relevant fields such as Sphere, Cylinder, Axis, and any medical conditions if necessary.
List any VISION EXPENSES incurred along with original receipts attached. Confirm if other health benefits apply and provide details if so.
Finally, review all entered information for accuracy before signing and dating the form at the bottom.
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