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Enrollment application & change of information Formosa Health use only Group numberSubscriber numberDental (24)To expedite your application, please print legibly in black or blue ink and return as

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How to fill out dental 2-4

01

Step 1: Gather all the necessary documents such as identification, dental insurance information, and any relevant medical records.

02

Step 2: Arrive at the dental clinic at the scheduled appointment time.

03

Step 3: Fill out the dental 2-4 form completely and accurately, providing all the requested information.

04

Step 4: Double-check the filled form to ensure all the information is correct and there are no mistakes.

05

Step 5: Submit the completed dental 2-4 form to the dental staff or receptionist.

06

Step 6: Wait for further instructions or appointments from the dental clinic.

07

Step 7: Keep a copy of the filled form for your records.

Who needs dental 2-4?

01

Anyone who is visiting a dental clinic and is required to provide detailed information about their dental history, current conditions, and any relevant medical information may need to fill out dental 2-4 form. This form helps the dental staff assess the patient's oral health, plan treatments, and keep a record of the patient's dental history.

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