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On October 10, we will be upgrading our phone system. This enhancement will improve your future experience. It may result in additional wait times during our transition. We appreciate your understanding and patience as we work to serve you better.

On October 10, our call center will be closed for staff training between 12 PM and 1 PM ET.
On October 9, due to the enhancement to our phone system, our IVR will be unavailable for self-service from 6.30 PM through 11:59 PM ET.

Dental Forms for Brokers

Find a variety of helpful forms or applications to keep your client’s information updated.

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Small group forms for brokers


Small Business Program Group Dental and Vision Application (PDF, 9 pages, 1,570 KB)

Delta Dental CT Enrollment Template (Excel Spreadsheet)

Enrollment/Change Form (Dental and Vision) (PDF, 1 page, 204kb)


Individual Commissions Forms


Producer Appointment Forms (pdf, 26 pages, 789KB)


Standard Forms for Brokers


Authorization Form Granting Access to PHI - Insured Clients (PDF, 3 pages, 52kb)

Authorization Form Granting Access to PHI - Self Funded Clients (PDF, 3 pages, 51kb)

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Small Group Forms

Use these forms and applications for your small groups

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Individual Commissions Forms

Get started on becoming an individual and family plan broker

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Standard Forms

Keep client information up to date

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