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Forms & Documents

Use the tabs below to find the right forms for you. If you can’t find what you’re looking for, check the Contact Us page and give us a call!

Guardian Members

Guardian PPO ADA Claim Form
HIPAA Authorization (English)
HIPAA Authorization (Spanish)

Member Grievance Forms
Guardian PPO
All States

Guardian DHMO
New York
Florida

Managed Dental Care
California

Managed DentalGuard
New Jersey
Texas

First Commonwealth
Illinois

Dependent Eligibility Certification Forms
Dependent Eligibility Certification Form – CO and FL
Dependent Eligibility Certification Form – CT
Dependent Eligibility Certification Form – IL
Dependent Eligibility Certification Form – MA
Dependent Eligibility Certification Form – MN
Dependent Eligibility Certification Form – NY
Dependent Eligibility Certification Form – OH
Dependent Eligibility Certification Form – PA
Dependent Eligibility Certification Form – All other states
Dependent Eligibility Certification Form – Student Certification
Dependent Eligibility Certification Form – Student & Dependent Certification

Premier/Access Members

Dentist Nomination Form
Dental Claim Form
HIPAA Authorization (English)
HIPAA Authorization (Spanish)
Notice of Privacy Practices (English)
Notice of Privacy Practices (Spanish)
Language Assistance Services
AZ Appeal Packet

Member Grievance Forms
Premier Grievance Form — PPO
Premier Grievance Form — DHMO (English)
Premier Grievance Form — DHMO (Spanish)
Premier Grievance Form — DHMO (Chinese)

Privacy Policies and Forms
Click here to view and download a complete list of Guardian privacy policies and forms.

Note: To use these forms you need Adobe Acrobat Reader installed on your computer.Get Acrobat Reader now »

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Learn More About Guardian

Guardian has been a trusted name in insurance for over 155 years. Today, we have one of the largest dental insurance networks in the country where you can save an average of 36% on dental procedures. Learn More About Guardian »

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Our Plans

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One size never fits all—find out what Guardian can offer you and your family.
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Documents & Forms

Documents & Forms »

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Whether you're looking for a new plan or are an existing member, we're here to help.

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