Get the free COAST DENTAL PA Family Members Benefit Election Form - Unum

Unuminfo. com/coastdental001 or in a paper enrollment kit. You can request a paper enrollment kit by calling 1-800-227-4165. DO NOT submit this form if you have not reviewed those materials. Underwritten by Unum Life Insurance Company of America LTC Department 2211 Congress Street Portland Maine 04122 COAST DENTAL P. Applicant s Signature Date Please sign and mail all required signature forms to Unum address at top of page. 7684-04 GLTC04-EF005-FAM rev 01. 05 Calculate Your Premium Please...

How to fill out coast dental pa family

How to fill out coast dental pa family

1. Obtain the Coast Dental PA Family form from their website or dental office.
2. Read the instructions and gather all the necessary information and documents.
3. Start by filling out the patient's personal information such as name, date of birth, and contact details.
4. Provide the patient's insurance information, including policy number and group number if applicable.
5. Specify any existing medical conditions or allergies the patient may have.
6. Fill out the dental history section, mentioning any previous dental procedures or treatments.
7. Indicate any specific dental concerns or issues the patient may be experiencing.
8. Sign and date the form to certify the accuracy of the information provided.
9. Submit the completed Coast Dental PA Family form to the dental office or as instructed in the form's guidelines.
10. Keep a copy of the filled-out form for your records.

Who needs coast dental pa family?

1. Individuals or families seeking comprehensive dental care can benefit from Coast Dental PA Family.
2. Those looking for a dental provider that offers a range of services, including preventive, restorative, and cosmetic dentistry, may find Coast Dental PA Family suitable.
3. Patients who want a dental office that accepts various insurance plans and can handle insurance claims on their behalf may choose Coast Dental PA Family.
4. Those experiencing dental issues or in need of specialized treatments, such as orthodontics or periodontics, can consider Coast Dental PA Family for their needs.
5. Coast Dental PA Family may also be suitable for patients who prefer a dental practice with experienced and qualified dentists and friendly, professional staff.

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