Get Local 891 Dental Forms

Filling out the Local 891 Dental Forms online is a straightforward process designed to help users efficiently submit their claims. This guide offers step-by-step instructions to ensure that you accurately complete each section of the form.

Follow the steps to complete your Local 891 Dental Forms online.

1. Click ‘Get Form’ button to access the form and open it in the appropriate editor.
2. Enter the patient name in the designated field. Ensure you print the last name first to maintain clarity.
3. Select the appropriate gender for the patient by marking either ‘M’ for male or ‘F’ for female.
4. Indicate the relationship to the member by choosing from the options: Self, Child, Spouse, or Other.
5. Input the patient’s date of birth in the required format to establish identity.
6. Next, enter the member name in the same format as the patient’s, with the last name first.
7. Select the member's gender using the same options as for the patient.
8. Fill in the member’s social security number accurately to avoid complications.
9. Input the member's date of birth in the specified section.
10. Complete the home address by providing the street number and name, along with the apartment number if applicable.
11. Fill in the city, state, and ZIP code for the home address to ensure proper processing.
12. Enter the member's payroll title to give context to their employment information.
13. Provide the home phone number, including the area code, for contact purposes.
14. Include the employer's phone number along with the area code.
15. Answer the question about whether the spouse is employed. If ‘yes’, provide the spouse’s employer name, address, and social security number.
16. Review the certification statement and sign to confirm the accuracy of the provided information.
17. Date your signature to validate the submission.
18. Finally, after filling out all necessary sections, save your changes, then download, print, or share the completed form as needed.

Complete your Local 891 Dental Forms online today for a seamless benefits claim experience.