Enrollee Forms

Looking for a form? You’ll find all our electronic and downloadable forms here, organized by topic and plan type.

Claim Forms

Delta Dental dentists will file claims for you. But if you decide to visit a non-Delta Dental dentist, you may need to file one of the following claim forms:

Delta Dental PPOSM, DPO and Delta Dental Premier® PDF icon 367 KB
DeltaCare® USA PDF Icon 276 KB
AARP Dental Insurance Plan

How to file a claim


Customer Service

Do you want to contact Customer Service online? Fill out the form, and we’ll get back to you via email.

Delta Dental PPO, DPO and Delta Dental Premier:

DeltaCare USA and DeltaVision®:

Online Services

Registration and login issues

Contact Us

By phone or mail


Grievance Forms

If you have a grievance, submit the relevant form for your plan:

Delta Dental PPO, DPO and Delta Dental Premier
Other languages: español | 中文 PDF icon343 KB
DeltaCare USA
Other languages: español | 中文 PDF Icon183 KB
DeltaVision
Other languages: español | 中文 PDF Icon286 KB
Denti-Cal/State, County and Local Dental Programs
Other languages: español | 中文 PDF Icon162 KB

Authorization Forms

DeltaCare USA Continuous Orthodontic Coverage PDF Icon26 KB
If you or an eligible member of your family has started orthodontic treatment under a previous dental plan sponsored by an employer/organization, you may be able to continue that coverage when you switch to a DeltaCare USA plan. Please have your treating orthodontist complete and submit this form along with a claim form within 30 days of your new plan’s effective date.
Disclosure of Health Information PDF Icon84 KB
This form authorizes Delta Dental to release your health information to an appointed representative, such as a family member.

How we use your health information

Online Services

Register Today

Username and Password help.


Health Care Marketplace (Exchange) Customers:

Check Your Enrollment Status

Find a Dentist

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