Before you start, here's what you need to know.
This form is designed for when you need to make a claim for temporary emergency dental treatment which took place when you were 40 miles or more away from your registered Denplan dentist.
Payment will be credited directly to the account held under your patient registration number. If someone else pays for your Denplan plan, such as another family member, then their account will be credited instead.
You will need to have the following to hand:
- Your details, including your Denplan membership number
- Details of the dentist that treated you
- Details of the appointment and the treatment you received
- A scan or picture of your receipt from the treatment in one of the following file formats - bmp, jpeg, jpg, odt, pdf, png or tif
Start your claim
Go back to the Making a Claim page »