Forms

Our member and provider services team is here to help you and your patients get the best dental care possible. We make sure any questions or concerns you have are addressed quickly and clearly. With Delta Dental, we keep you smiling. There’s no hassle in working through claims, saving you time and frustration.

Dentist Forms 

• Appeal Form - Information on how to appeal your claim 
• Delta Dental Premier Network Forms - Professional Application & Credentialing form, Delta Dental Premier Dentist's Agreement, Ownership & Control Form and W-9
• Delta Dental PPO Network Forms - Delta Dental PPO Supplemental Agreement
• Dental Wellness Plan Application - DWP Agreement

• Hawki Orthodontic Network Forms - Hawki Orthodontic Agreement

Member Information

• Enroll Member for Enhanced Benefits Program - Additional dental benefits based on certain medical conditions (not available on all plans)