Get the free Guardian Dental Claim Form - Wadley Regional Medical Center at...
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DENTAL PROTECTION EXTRA Program HOLDER TRANSFER FORM UK0800 561 9000 (Mon Fri: 8.00am 6.30pm) member. Help dental protection.org dental protection.org Please complete all parts of this form in BLACK
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How to fill out guardian dental claim form
How to fill out guardian dental claim form
01
Fill out the patient's personal information section, including their name, address, and contact information.
02
Provide the policyholder and insurance information, including their name, policy number, and group number.
03
Indicate the date of the dental procedure or treatment for which you are filing a claim.
04
Clearly state the procedure codes and descriptions of the services rendered.
05
Enter the total charges for each procedure.
06
Sign and date the form, certifying that the information provided is accurate and complete.
07
Attach any supporting documentation, such as receipts or itemized bills, as required.
08
Submit the completed form along with the supporting documents to the designated address specified by Guardian Dental.
Who needs guardian dental claim form?
01
Anyone who has dental insurance coverage with Guardian Dental and has received dental treatment or procedures that are covered under their policy will need to fill out a Guardian Dental claim form.
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