Our forms are available online as Adobe AcrobatTM (PDF) forms. To view and print these forms, you will need the free Acrobat Reader, which you can download here.
You may either complete the forms on your computer and print them out completed, or print the blank form and fill it out by hand.
Claim Form pdf
Download this form before you see your provider.
Non-Elective(Medically Necessary) Contact Lenses Approval Form pdf
Download this form and give it to your doctor to get approval for contacts.
HIPAA - Patient Authorization Form pdf
This form authorizes MES to release your medical information to the providers you specify.
This document describes your privacy rights with MES. Please print this document and save it in your records.
Independent Medical Review Form PDF pdf
Download this form to request a Independent Medical Review (IMR) from the DMHC .
