Dental Forms Library for Employers
Find the application or form that relates to your needs and easily download and print, or submit online.
Authorization Form Granting Access to PHI - Insured Clients (PDF, 3 pages, 52kb)
Use this form when coordinating dental benefits with another dental coverage provider (e.g., your spouse's coverage).
Authorization Form Granting Access to PHI - Self Funded Clients (PDF, 3 pages, 51kb)
Use this form to file a claim for services performed in the United States.
Change Transmittal Form (PDF, 2 pages, 127kb)
Use this form to file a claim for services performed outside the United States.
Eligibility Enrollment Change Form (PDF, 2 pages, 22kb)
Use this form to view overage dependents information or if you're
Certification of Handicapped Child's Dependency Status (PDF, 1 page, 13kb)
Use this form to view overage dependents information or if you're
