Broker Forms

Registration Forms:

• Broker Registration Form
• Broker Commission On Line Registration Form
• W-9

Claim Forms:

• Dentcare Claim Form
• Healthplex Claim Form

Group Applications:

• Dentcare Group New York
• IHS CapDent/CapDent Plus New Jersey
• Healthplex Preferred Choice (H7) New York

Group Payment:

• Dentcare
• Healthplex

Other:

• Group Transmittal Form
• Subscriber Change Form
• Dependent Student Certification Form
• Direct Deposit Form
• Enrollment Form

Among the first known dentists in the world were the Etruscans. In 700 BC they carved false teeth from the teeth of various mammals, and produced partial bridge work good enough to eat with.