Dental Claim Form Template

Share this dental claim form with your patients to improve your dental services, optimize your internal processes and digitize your dental business. To customize this dental claim form template, use our form builder.

Customize template

No coding skills? No problem! You can adapt this dental claim form template any way you like using an easy drag-and-drop editor. The dental treatment insurance claim’s questions can be in just about any format, such as radio buttons, checkboxes, file uploads, and more. Furthermore, you can personalize of the form’s look and feel, from choosing your own fonts and colors to adding your logo.

Publish template

Once you’ve perfected your online dental claim form, it’s easy to implement on your website. Just copy and paste the form embed to the source code of a web page and that’s it! The mobile responsive design looks and works great on all screen sizes. The form will automatically stay up-to-date on your website even if you revise the form later. If you also want to send it out over email or social media, handy share buttons let you post in a matter of clicks.

Collect & manage data

Each dental claim form submission goes to a secure database that you can access easily on your 123FormBuilder dashboard. You can refer back to any insurance claim individually or export it to PDF for filing or printing. Alternatively, you can export some or all submissions to Excel/CSV or generate analytics. Finally, don’t forget to integrate your online dental claim submission form with any of the productivity apps you already use.

Optimize processes

An online dental claim form can make the administrative side of your dental practice sparkle like your patients’ smiles. By gathering dental claim data in an online form, you can reduce errors (and paper waste!) processing patient, treatment and insurance data. What’s more, you can you can have every submission sent in real time to every individual involved in the billing process.