Forms
Appeals & Grievances
Online Fillable Form
Member Forms & Documents
We make using your dental benefits easy. Browse our library of member forms and documents to find important resources you may need to manage your Delta Dental of Arizona plan. Additional forms may be available in the member portal. If you still can't find what you're looking for, please feel free to contact us.
EFT Authorization: Direct Billing Members
Online Fillable Form
Enrollment/Change of Status Form
Downloadable Form
Solicitud de Inscripción/Modificación
Downloadable Form
HIPAA Release - Group Plan Members (English/Spanish)
Downloadable Form
HIPAA Release - Individual Plan Members (English/Spanish)
Downloadable Form
Additional Resources & Documents
Member Portal Registration Instructions
Informational Flyer
Out-of-Country Claims Submission (English/Spanish)
Informational Document
Printable Dentist Directory
Informational Document (updated monthly)
Member Portal Demo Videos
Note: The following videos do not contain sound.
Creating a Member Portal Account
View Benefits & Eligibility
View Claims
View/Print ID Cards
Finding a Network Dentist
Update Account Information
Forgot Username/Password
