Provider Forms

• ADA Attestation
• Credentialing Package - Dentist Personal Profile
• Healthplex Claim Form
• Healthplex Provider Manual
• Provider Inquiry Request for Clarification Form
• W-9/Office Information Form

Orthodontic Templates

• Dismissal Letter
• Braces Removal and Retainer Consent Form
• Orthodontic Treatment Progress
• Consent Form
• Release From Treatment - Provider
• Release From Treatment - Patient Request
• Dental Clearance Note