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Forms

For your convenience, we've posted some forms that you commonly use in your day-to-day transactions with us or with your employees. For example, an employee visiting a non-participating dentist may need a copy of a claim form.

If your browser is set up to use Acrobat reader, you can click on the links below to download an Adobe Acrobat PDF. Then print the form, complete and sign it and return it to us.

Delta Dental of Rhode Island
PO Box 1517
Providence, RI 02901-1517

Delta Dental Automatic Payment Form
Direct Electronic Access Agreement* (Return completed form to your Account Executive)
Claim Form
Communication Order Form
Handicapped Dependent Form
Student Certification Form
Authorization To Release Protected Health Information

*Please note: It takes approximately two weeks to process a complete Direct Electronic Access Agreement. Until you receive your User ID and Password, please forward subscriber changes and additions directly to the enrollment department via fax at 1-800-796-4971.

Depending on your Internet connection, this file may take a moment or two to download. Click the icon to download the latest version of Acrobat Reader free from Adobe.