Fill Up And Sign The Dental Availment Form

After the dental treatment, patient may be provided discharge instructions such as prescriptions or Post-operative instructions whenever applicable.

Patient must sign the HPDAI dental availment form after the procedures have been availed.

• Please check all services indicated on the dental form since these will be deducted from your dental benefits.
• Sign one (1) form only per date of visit.
• Provide your active contact details for validation of availed dental procedures.
• For services availed other than those covered must be paid directly to the dentist.