Dental Insurance Information Form

Form Template

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Why make your staff re-enter the same dental plan information your patients just wrote on your paper forms, when the patient can enter all the health insurance information directly online. Use the Dental Insurance Information Form Mobile App in your waiting room, and you will be sure that your patient records accurately depict their dental coverage and are ready for immediate access.

Simply email or text the dental benefits form to the patient before their next dental visit, or have them enter the information on their Smartphone while in the waiting room. Collect information about their insurance coverage including insurance company, group number, member ID, insured's name and relationship, employer.

Include verbiage indicating your claim requirements and that the patient is responsible for out-of-pocket costs for dental fees for any dental services for them and all family members that are under the dental program. Collect the signature electronically to complete the form, and have it sent directly to your waiting office staff.

The app is simple and flexible allowing you to adjust the information you capture to fit your dentist needs. All the information is stored conveniently and securely on the GoCanvas Cloud and is easily accessible to you from all of your connected devices.

GoCanvas has all the dentists apps you've been looking for.

  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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  • iPhone
  • iPad
  • Android
  • Windows
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  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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