Forms for Our Patients and Their Families

Find helpful forms to assist you in utilizing your dental benefits.

Business Forms

• Claim Form  
• Dependent Verification Request Form  
• Enrollment Change Form – Dental  
• Enrollment Change Form – Vision  
• Payment Option Form

Informational Memos

• Benefit Lookup Flyer
• Benefit Lookup Fyer (Spanish) 

Compliance

• Individual Release of PHI Authorization 
• HIPAA Privacy Notice
• Privacy Complaint Form  
• Martin's Point Generations Advantage Patients
  • Medicare Opt–Out Acknowledgement and Financial Responsibility Form  

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