Dental Form

To fill out the Dental Form, you must follow the ANS rules (mandatory fields). After filling out, you need to:

1. Click Confirm to save the form.
2. Click Print to view the form receipt.
3. To use Form Authorization/Cancel Status, enter the Form number and click Display.
4. To use Eligibility, enter the user registration number and click Display.
5. To use Dental Payment Statement, enter the month and year and click Confirm.
6. To use Dental Request Form, in Remote, access Updates / Service / Release Dental. After filling out the form, click Ok to save it.