Get the free Dental Continuation of Care Request Form

5/2019Dental Continuation of Care Request Form Crowns / Inlays / Inlays Note: Only eligible orthodontia, crowns, inlays and inlays will be considered for Continuation of Care exceptions. For orthodontia,

How to fill out dental continuation of care

How to fill out dental continuation of care

1. To fill out dental continuation of care, follow these steps:
2. Start by providing your personal information such as your name, address, and contact details.
3. Specify the name of your dental clinic or healthcare provider.
4. Indicate the date of your last dental visit or appointment.
5. Describe any ongoing dental treatment or procedures you have received.
6. Mention any medications or allergies you have that may be relevant to your dental care.
7. Provide information about your dental insurance coverage, if applicable.
8. Include any additional comments or concerns you may have regarding your dental care.
9. Sign and date the dental continuation of care form.
10. Submit the completed form to your dental clinic or healthcare provider.
11. Remember to double-check all the information you have provided before submitting the form.

Who needs dental continuation of care?

1. Dental continuation of care is needed by individuals who:
2. - Are undergoing ongoing dental treatment or procedures and need to transfer their care to a new dental clinic or healthcare provider.
3. - Have recently changed their dental insurance coverage and need to update their information with their dental provider.
4. - Want to ensure a seamless transition of their dental care when switching healthcare providers.
5. - Have specific dental concerns or conditions that require consistent and uninterrupted follow-up care.

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