Dental Home Change Form - DentaQuest 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your personal information. Enter your first and last name, Medicaid ID (if known), date of birth in the format dd/mm/yyyy, contact phone number, and email address. Ensure all required fields marked with an asterisk (*) are completed.
3. Next, provide details about your preferred dentist. Fill in the dentist's name, city, address, zip code, and phone number. Additionally, include the date of your last visit to this dentist.
4. Once all fields are filled out accurately, review your entries for any errors before finalizing the form.
5. After confirming that all information is correct, you can save or print the form directly from our platform for mailing or faxing to DentaQuest.

Start using our platform today to easily complete your Dental Home Change Form for free!