Get Main Dental Home Dentist Change Request Form - Dentaquest

The Main Dental Home Dentist Change Request Form - DentaQuest is essential for members who wish to select a new Main Dental Home Dentist. This guide will provide step-by-step guidance on how to fill out the form accurately and submit it effectively.

Follow the steps to complete the dental home dentist change request form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the member's first name and last name in the designated fields.
3. Provide the member ID, ensuring that it is accurately recorded as this is a crucial identifier.
4. Fill in the date of birth in the format mm/dd/yyyy, which helps confirm your identity.
5. Input the contact phone number in the specified format (###-###-####) for communication purposes.
6. Indicate the best time to call by specifying morning, afternoon, or evening hours.
7. Enter the email address for any electronic correspondence regarding the change request.
8. Next, sign the form in the Member Signature section to authorize DentaQuest to reassign your Main Dental Home Dentist as specified.
9. In the Main Dentist Detail section, provide the preferred dentist's name, address, city, and zip code.
10. Enter the dentist's phone number in the proper format (###-###-####) for direct contact.
11. Document the date of the last visit to this dentist, which is important for scheduling purposes.
12. Review all entered information for accuracy, then save changes, download, print, or share the form as needed.

Complete your Main Dental Home Dentist Change Request Form online today to ensure timely processing.