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Dental Forms Library for Employers

Easily download and submit the form or application that relates to your needs.

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)

Eligibility Enrollment Change Form (PDF, 2 pages, 22kb)
Use this form to submit new adds, changes, and terminations.


COBRA Application 
(PDF, 1 page, 63kb)

Certification of Handicapped Child's Dependency Status
 
(PDF, 1 page, 13kb)
This form officially certifies the dependency status of a handicapped child. To be signed by the child's physician.