Member forms

Return completed forms to: Delta Dental, PO Box 103, Stevens Point, WI 54481

ADA Dental Claim form – sign in to download form
Use this form for standard dental claims.

Personal Representative form
Use this form to appoint a personal representative to act on your behalf.

HIPAA Authorization form 
Use this form to authorize the release of your history information.

Disability form and Proof of Disability form
Use these forms to provide proof of a dependent's disability status.