Let's get some information before we get started.

In order to get this going, we just need some basic contact information from you. We’ll use it to contact you about the details of your coverage.

Are you the policyholder or a dependent?

The policyholder is the person who "owns" the insurance and is responsible for payments. Dependents are people that the policyholder picks to have covered under their plan.

Policyholder information

Are the aligners for you or someone else in your family?

If the aligners are for someone in your family, they must be on your insurance plan.

Patient information

Insurance provider information

health fund