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  Forms

 

Forms on this page are for the use of DIS Clients and are in Adobe Acrobat format.  If you don't have Acrobat Reader, you can download a copy here for free.

Field Referral Form

 

SLC Forms - Attending Physician's Statement - STD.pdf

SLC Forms - Authorization - SLC - HIPAA.pdf

SLC Forms - Notice of Claim - CS and ER for STD.pdf

SLC Forms - Attending Physician's Statement - Full LTD.pdf

SLC Long Term Disability Questionnaire.pdf

 

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