Dentist insurance, risk management and business liability for dentists
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DENTISTS BENEFITS INSURANCE COMPANY

Created exclusively for dentists by dentists, DBIC is committed to helping you and your staff. Our trained professionals serve as a resource for your practice, and we are happy to assist with dentist insurance questions, proper documentation, risk management services and much more.

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RISK MANAGEMENT
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  • Insurance Terms

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Risk management forms

General

  • Authorization for Release of Information for Employment Purposes
  • Authorization to Disclose Healthcare Information
  • Dismissal Letter
  • Insurance Verification
  • Patient Information
  • Patient Information (Dental Questionnaire)
  • Periodontal Chart

Claim forms

To submit a claim, contact our claims department at 800-452-0504, or complete the appropriate claim form below and submit online.

  • Property Loss
  • Liability Loss
  • Quick Claim Form

Consent forms

  • Appliance Release Payment Agreement
  • Consent for Amalgam Replacement Procedures
  • Consent for Bisphosphonate
  • Consent for Bleaching Teeth
  • Consent for Composite Fillings
  • Consent for Cosmetic Treatment
  • Consent for CT
  • Consent for Crown and Bridge Prosthetics
  • Consent for Dental Implants
  • Consent for General Dentistry
  • Consent for Extraction
  • Consent for Oral Surgery
  • Consent for Nitrous Oxide
  • Consent for Occlusal Equilibration
  • Consent for Peridontal Cleaning
  • Consent for Periodontal Disease
  • Consent for Periodontal Procedures Scaling Root Planing
  • Consent for Pulpotomy
  • Consent for Root Canal Treatment
  • Consent for Sealants
  • Consent for Silver Amalgam Restorations
  • Dental History & Consent for Treatment
  • Informed Consent Permission Form
  • Kinship Caregivers Informed Consent Declaration for Minors
  • Refusal of Recommended Treatment

We would like to gratefully acknowledge the assistance from Schatz and Company and Omsnic with the consent forms

Dentists Benefits Insurance Company
10505 SE 17th Ave, Milwaukie, OR 97222
503-765-3510 • 800-452-0504 toll free
503-765-3511 fax •

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