Davis Duehr Dean Patient Forms
Please download, print and fill out the form(s) below only if you have been requested to do so by a Davis Duehr Dean ophthalmologist, optometrist or a member of our staff. Bring the completed form(s) with you to your clinic visit.
Insurance Authorization Form (PDF) — This form is used to verify your insurance coverage. We need this form completed and signed in order to file a claim to your insurer.
Permission for Verbal Communications Form (PDF) — This form allows a patient to identify and give permission for other individuals (family members, etc.) to discuss your health information and treatment without you being present. If you'd like to learn more, visit the Permission for Verbal Communications section.