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Get Dentaquest Orthoselect Form
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How to fill out the Dentaquest Orthoselect Form online
Filling out the Dentaquest Orthoselect Form online can streamline your application process for orthodontic discounts. This guide will walk you through each section of the form, ensuring you complete it accurately and efficiently.
Follow the steps to fill out the Dentaquest Orthoselect Form.
- Click the ‘Get Form’ button to access the Dentaquest Orthoselect Form. This will allow you to open the form in your online editor.
- Begin by entering the name of the covered individual. Ensure you fill in their last name, first name, and middle initial correctly in the designated fields.
- Provide the street address of the covered individual, including the city, state, and zip code. Accuracy is important to ensure proper communication.
- Input the individual’s Social Security number. Please ensure this information is accurate to avoid processing delays.
- Enter the home telephone number and, if applicable, the work telephone number. This information may be used for follow-up purposes.
- Fill in the date of birth of the covered individual to verify eligibility and ensure proper processing.
- Complete the section for the name of the responsible party, mirroring the steps for the covered individual’s name entry.
- Indicate the relationship of the responsible party to the covered individual in the provided field. This helps clarify the responsible party's role.
- Select the method of payment by checking the appropriate box for either check, money order, or credit card. If using a credit card, complete the account number, name on the card, expiration date, and provide an authorized signature.
- Review all entered information for accuracy. Ensure that every field is filled out completely before proceeding.
- Save your completed form, then download or print it for your records. Finally, share or mail the form as instructed to DentaQuest at the provided address.
Complete your Dentaquest Orthoselect Form online today to secure your orthodontic discounts.
Dental Corp is one of the prominent networks partnering with DentaQuest, with several locations across the country. They focus on providing high-quality dental care, making it easy for patients to seek treatment. Having such a large network means you can access a variety of services conveniently. Utilizing the DentaQuest Orthoselect Form can help guide you to a Dental Corp location near you.
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