Get Dental Application - Parseofpa.org

Completing the dental application can seem overwhelming, but understanding each section will help simplify the process. This guide will provide you with clear, step-by-step instructions on how to fill out the Dental Application accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to obtain the application and access it in your preferred form editor.
2. Begin by entering your personal information. This includes your first name, middle initial, last name, social security number, street address, city, state, zip code, phone number, birth date, sex, and email address. Ensure that all information is printed clearly to avoid any processing delays.
3. Indicate your desired coverage option by checking the appropriate box: Individual, Two-Party, or Family. The annual premium amounts for each coverage level are also outlined in this section.
4. List any dependents who will be included in your application. For each dependent, provide their name, social security number, sex, birth date, and indicate if they are disabled. Remember, additional steps may be required for disabled dependents over the age of 26.
5. Select your payment method. Choose from enclosed check, money order, or credit card. If using a credit card, enter the card number, type, cardholder's name, expiration date, and CVV code, along with your signature to authorize the payment.
6. Read the important agreement statement carefully. This section outlines the conditions of your application and the consequences of providing false information. You will need to sign and date this portion.
7. Once the application is complete, save any changes you have made. You will then have the option to download, print, or share the completed application for submission.

Complete your dental application online today for seamless processing and coverage.