Forms for Members

This form is to authorize the release of your Protected Health Information (PHI) such as dental claims history, benefits information, etc. to someone else (for example: your spouse, your daughter or son, etc.).

This form is for Individual Dental Plan members only. To make a change to your Individual Dental Plan online, please log onto the HDS Member Portal. If you have a group plan through your employer, please contact your company’s benefits administrator to make updates to your plan information.