Follow the steps to successfully complete your dental claim form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred PDF editor.
2. Enter your main member details accurately. This includes your Bupa membership number, title (Mr, Mrs, Miss, Ms, or Other), first name(s), surname, address, postcode, and date of birth.
3. Provide your daytime, evening, and mobile telephone numbers, along with your email address. This will facilitate communication regarding your claim.
4. Indicate whether you consent to being contacted by telephone or email for faster claims processing. If you do not wish to be contacted, tick the appropriate box.
5. If the claimant is not the main member, fill in the claimant's personal details, including their title, first name(s), surname, relationship to the main member, and date of birth.
6. Select your payment preference: cheque or BACS (Bank Automated Clearing System). If opting for BACS, provide the account holder's name, account number, and sort code.
7. Complete the NHS treatment details section if applicable, including any NHS banding and patient charges.
8. Fill in the treatment details by ticking the types of treatment received and noting the treatment date(s) and total charges.
9. If you experienced a dental injury, complete that section with details of the cause and circumstances.
10. Complete the treating dentist section with their provider number, name, practice name, and address.
11. Review all the completed sections to ensure accuracy and completeness.
12. Sign the claimant declaration, confirming that the information is true and correct, and providing the date of signature.
13. Once all sections are complete, save your changes, download the form, and print or share it as necessary. Finally, send the form to Bupa Dental at the specified address.

Complete your claims process online today by filling out the Download Bupa Dental Claim Form.