Get Instructions: And Your Childs Eyeglass Receipt(s) Note

Filling out the Instructions: And Your Childs Eyeglass Receipt(s) Note form online can ensure a smooth application process for getting coverage for your child's eyewear. This guide provides step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. In Part 1, fill out the patient information. Provide your last name and first name as the parent or guardian, along with the address, city or town, postal code, and province. Enter your child's last name, first name, social insurance number, and birth date indicating the day, month, and year.
3. Ensure to mark the box confirming that you understand the privacy protection statement, which explains how your personal information will be used. Sign the form, and include the date to affirm that the provided information is accurate.
4. In Part 2, have your eye care provider fill out the prescription details. This includes the sphere, cylinder, axis, prism details, and additional prescription information. It is crucial that these details are accurate and properly filled out by a legally qualified Manitoba eye care provider.
5. Specify the reason for the purchase by checking the relevant box. Options include whether it is an initial prescription, a prescription change, or other reasons.
6. In this section, list the costs associated with the lenses and frames. Provide any other costs incurred and calculate the total cost.
7. Finalize Part 2 by having your eye care provider sign the form and provide their phone number along with the date of purchase.
8. Once you have completed both parts of the form and obtained all necessary signatures, you can mail or fax the completed claim form along with your child’s eyeglass receipt(s) to the specified address.
9. Make sure to send your claim within 14 months of the date you purchased the glasses. Additionally, confirm that you meet the eligibility criteria outlined in the instructions.
10. Save any completed forms for your records. You may choose to download, print, or share the form as needed.

Complete your documents online today to ensure your child's eyeglass expenses are covered.