Enrollment Forms

Two ways your employees can enroll:

Complete an enrollment form online (PDF), print it and sign it. Then, submit it to your company's human resources department for review and submission to Delta Dental for processing. 

Download an enrollment form (PDF), print it, manually complete and sign the form. Then submit the form to your company's Human Resources department for review and submission to Delta Dental for processing. 

Once you have reviewed the enrollment form, please email or fax a copy to your Group Accounts Representative at the contact information linked below.

Contact List (PDF)

If you don’t know who your Group Account Representative is, please email GAService@deltadentalmo.com.