Forms

At Delta Dental, we want to make selling our products as simple as possible. We have made available for download important forms to ensure you have everything you need just a click away.

Group & Enrollment

Claim Form
2-9 Client Information Form
Client Information Form
Membership Enrollment Form
Spanish Membership Enrollment Form
HIPAA Designated Contact Form
COBRA Premium Subsidy Recap
COBRA Election Form for ARRA (for groups with fewer than 20 full-time employees)

Agent Forms

Add Agent Form
Remove Agent Form
Authorization for Direct Deposit of Commission Checks

Agent Appointment forms can be found on the Represent Delta Dental page. 

PLEASE NOTE: Delta Dental of North Carolina accepts standard ADA claim forms.

If the information you are looking for is not available here, contact your Account Manager.