Individual Authorization to Release Protected Health Information

Healthy Smile, Healthy You® enrollment form

Healthy Smile, Healthy You® enrollment form — Spanish

Nominate an out-of-network dentist to participate with Delta Dental

Nominate a Delta Dental Premier® dentist to participate in Delta Dental PPO™

Looking for a claim form? If you visited an out-of-network dentist, log in to download a claim form.