Downloadable Forms

Our most commonly requested forms are available for download. The documents are available in an Adobe® Acrobat® portable document format (PDF). Simply click on the title of the form you wish to download.

Dental Deductible Carry-over Credit Report for NY and PA (2576)

Dental Service Report (Claim Form) for NY and PA (1248)

Employee Dental Application for Enrollment or Change for NY (4518)

Employee Dental Application for Enrollment or Change for PA (8646B)

Dentist Recruiting Request Form for NY and PA (6023)

Rayant Dental Discount Plan for NY/PA (2764)

Transmittal of Deletions form for NY and PA (2933)

Authorization for Disclosure of Protected Health Information (6040)