Dental Claim Form
Complete this form when seeking approval of dental claims.
Document
dentalclaim_2017_v3.pdf
(341.62 KB)
Hearing Loss Exception to Benefits Form
Complete this form when seeking approval of devices or services that are different from those outlined in the WCB Hearing Health Services Guide.
Document
Hearing Loss Exceptions Form Final.pdf
(87.85 KB)
Audiometric Report
Audiometric report to be completed by service provider.
Document
Audiometric Report.pdf
(302.32 KB)
Physician – Assistive Devices Request Form
Form to be completed by physicians for the request of an assistive device.
Document
Assistive_Devices_Form_Physician.pdf
(32.88 KB)