Forms- Dean - WI

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Davis Duehr Dean Eye Care 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 Eye Care 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.

Please note that when you check in at our registration desk, you will be asked to review and sign a Notice of Privacy Practices form. You may wish to read our health information privacy policy before your clinic visit.

Use Those Flex Dollars

You can use your flexible spending dollars for:

• Refractive surgery
• Prescription eyeglasses and sunglasses
• Complete eye exams
• Contact lenses (including colored contact lenses)

Before you set aside your flex dollars for refractive surgery, see us for a free consultation to ensure you are a candidate for the surgery.

Watch Our Animations

Davis Duehr Dean Eye Care is proud to offer more than 50 physician-approved animations on a variety of eye conditions and procedures. Animations on glasses and contacts are also available.

Watch today!

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