Get Associate Add Or Term Request
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Open form follow the instructions
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How to use or fill out the Associate Add Or Term Request online
Filling out the Associate Add Or Term Request online is a straightforward process designed to support currently active dentists in managing their associates. This guide will walk you through each step of the form to ensure that your submission is complete and accurate.
Follow the steps to successfully complete your request.
- Click 'Get Form' button to obtain the form and open it in the editor.
- In section B, if you are adding an associate dentist, provide the primary location details, including street address, suite, telephone number, TIN, and public email address.
- In section D, if you are terminating an associate dentist from a location, complete the required fields such as street address, suite, telephone number, and TIN. Clearly indicate the termination reason, either 'Associate Dentist – No Longer at Location' or 'Associate Dentist is no longer with Group – Term from all Locations'.
- Finally, in section F, sign and date the form to confirm your authorization. Without a signature, the termination requests may not be processed.
Complete your Associate Add Or Term Request online today to manage your associates effectively.
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