Alberta dental hygiene claim form 2026

1. Click ‘Get Form’ to open the Alberta Dental Hygiene Claim Form in the editor.
2. Begin with Part 1, where you will enter the Registered Dental Hygienist's details. Fill in the last name, first name, address, city, province, postal code, and telephone number.
3. Next, provide the Date of Service by selecting the day, month, and year. Ensure accuracy as this is crucial for processing your claim.
4. In the section labeled 'Registered Dental Hygienist Use Only', input the office number and CDHA UIN #. Include any relevant service codes and tooth codes as applicable.
5. Detail the services provided along with any laboratory charges. Make sure to calculate and enter the total cost accurately.
6. Proceed to Part 2 to fill in your personal information as an employee or plan member. This includes your group policy number, date of birth, and gender.
7. In Part 3, if applicable, provide client/patient information including their relationship to you and any other insurance details that may apply.
8. Finally, review all entered information for accuracy before signing at the bottom of each relevant section. Once completed, submit your claim form as instructed.

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