Washington Dental Service Release of Information Authorization Form

The Release of Information Authorization form below is required for the release of dental claims history or benefits information to a personal representative of the patient.

Open the Authorization form here.
Questions? Call Washington Dental Customer Service at (800)554-1907, Monday through Friday, between 8 am and 5 pm PT.
Dentist
Looking for a Dentist?
Washington Dental Service can help. You can use the Find a Dentist tool to search and locate a qualified dentist in your area.
Go Paperless
Not a WDS member? Prefer to stick with paper? You can have a chance at $10,000! Just print and mail this entry form. No purchase necessary. Restrictions apply. See official rules for odds and other terms and conditions.