Dental Forms

Small Group

Small Group Application

Employee Enrollment Form

Website Authorization for Pool-Rated Groups

Small business ACH form

Large Group

Employee Enrollment Form

Website Authorization form for risk groups

Website Authorization form for ASC groups

Other Forms

Individual Application

Dental Agency/Agent Data Request

Broker Information Change Request

Direct Deposit Authorization

HIPAA Form 14a — Risk Groups

HIPAA Form 14b — ASO Groups

Website Reports Authorization

Broker Website Form — Apply to Administer Group

Automatic bank draft authorization for risk groups

Vision Forms

Small Group Application

Small Group Enrollment Form

Direct Deposit Authorization

Vision Agency/Agent Data Request

Vision HIPAA Form 14a — Risk Groups

Vision HIPAA Form 14b — ASO Groups