Templates Business Operations Dental Insurance Form Template

Dental Insurance Form Template

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Patient Information

Patient Address

Policyholder Information

Policy Holder Address

Insurance Company Information


Policy Information

Do you run a dental practice? You’ll need a few different types of forms to keep things organized. One of these will be a dental insurance form to help collect patients’ insurance details so that you can make payment claims. The WPForms’ Dental Insurance Form Template does this efficiently.

What Goes Into a Good Dental Insurance Form Template?

A dental insurance form can be complex.  A good one should have at least 3 distinct parts: First, a section for patient information, then a section for policyholder information, and finally, a section for information on the insurance policy itself.

The WPForms Dental Insurance Form Template is set up to take this into account. The patient information section uses basic Name, Email, Phone, and Address fields to capture basic Patient data. This section of the template also includes a Relationship dropdown field with 3 options: Spouse, Child, and Self.

The Policy Holder section contains a selection of similar fields minus the Relationship field. However, users who choose Self from the Relationship field will have the Policy Holder section hidden from them using conditional logic.

Next, there is the Insurance Information section, which comes with basic single-line text fields for the insurance company’s name, contact, and address details.

Additionally, the Dental Insurance Form Template has a section for information on the policy. The fields in this section are all single-line text fields designed to collect short answers.

Finally, the template wraps up with a paragraph text field for collecting any additional information and a signature field.

Get started with WPForms today to create and customize your own dental insurance form. Signing up with WPForms gives you access to this and hundreds of other pre-made templates.