Forms & Resources

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• Finding a Network Dentist

• Finding a Vision Provider

• **Authorization Form** - Authorization to release personal health information

• **Personal Representative Form**

• Dental Enrollment Form — English — Use this document if you will be filling out the form by hand.

• Dental Enrollment Form with Form Fields — English — Use this document only if you will be filling out the form via computer.

• Dental Enrollment Form — Spanish Language

• DeltaVision Enrollment Form — English Language — Use this document if you will be filling out the form by hand.

• DeltaVision Enrollment Form with Form Fields  — English Language — Use this document only if you will be filling out the form via computer.

• Dental and Vision Enrollment/Change/Waiver Form — Use this document if you will be filling out the form by hand.

• Dental and Vision Enrollment/Change/Waiver Form with Form Fields — Use this document only if you will be filling out the form via computer.

• ACH Form for Fully-Insured Groups — Make payments the easy way with ACH

• ACH Form for Self-Insured Groups — Make payments the easy way with ACH

• Dental Claim Form

• Vision Claim Form