Get Download Bupa Dental Claim Form

This guide provides step-by-step instructions for completing the Download Bupa Dental Claim Form online. Following this process will help ensure a smooth submission of your dental treatment claims.

Follow the steps to complete your dental claim form effectively.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Fill in the main member details. Ensure to include the Bupa membership number, title, forenames, surname, address, date of birth, and contact numbers including daytime, evening, and mobile.
3. Complete the fast track claims section. Indicate whether you consent to being contacted via telephone or email regarding your claim.
4. If the claimant is not the main member, complete the claimant’s personal details section. Provide the title, forenames, surname, and specify the relationship to the main member.
5. In the dental treatment details section, this must be filled out by your dentist or an authorized member of the dental practice. They should provide treatment procedure codes, descriptions, tooth notation, the number of treatments or teeth, treatment dates, and total patient charges.
6. If applicable, fill in the section for NHS banding if the treatment was received under NHS. Tick the appropriate band and enter the total treatment cost.
7. Proceed to the dentist’s declaration. The dentist must confirm the services provided, sign, and stamp the form.
8. Complete the claim details section, ensuring to include the total treatment cost and number of receipts enclosed.
9. Fill out the payment details. Decide if you prefer to receive payments via BACS or cheque and tick the appropriate box.
10. Read the data protection notice and ensure you understand how your data will be handled.
11. Sign the claimant declaration, confirming all information is correct, and date the form before submission.
12. Once all fields are completed, save your changes, download, print, or share the form as necessary.

Complete your dental claims online to ensure a timely and efficient process.