Get Eye Examination Waiver Form - Illinois Department Of Public Health - D131

This guide provides clear, step-by-step instructions for filling out the Eye Examination Waiver Form - Illinois Department Of Public Health - D131 online. Designed for users of all backgrounds, it aims to simplify the process and ensure a successful submission.

Follow the steps to complete the Eye Examination Waiver Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the student’s full name in the designated fields: Last name, First name, and Middle initial. Provide the student’s birth date using the format Month/Day/Year.
3. Fill in the school name and grade level, and select the student's gender by marking the appropriate box.
4. Input the complete address of the student, including number, street, city, and ZIP code. Additionally, add a valid phone number, including the area code.
5. Provide the full name of the parent or guardian in the specified fields: Last name and First name.
6. Enter the address of the parent or guardian using the number, street, city, and ZIP code fields.
7. Select the reason for the waiver by marking the applicable box. There are options related to medical assistance availability, lack of coverage, and other reasons for not obtaining an eye examination.
8. If applicable, describe any additional undue burden or lack of access to an optometrist or physician in the provided space.
9. Sign the form to confirm the information provided is accurate. Date the form in the specified area.
10. Once all required sections are completed, save your changes, and proceed to download, print, or share the completed form online.

Complete your Eye Examination Waiver Form online today for a seamless submission.