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Download Group Dental Forms

Easily access and download small group dental forms and applications.

Fidelity Security Life Insurance Company

Dental Design Sales Brochure
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Allied Dental Design Sales Brochure
Employer Administrative Guide

Guide for employers to administer group benefits
Employee Enrollment/Waiver

Dental Design Employer Application

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Self Service Site Administrator Authorization Form
Form employees use to enroll or waive coverage.

Multi-state dental employer application. Call Allied's Sales Support 888-767-7133 for state-specific applications for: CA, CO, FL, GA, ID, KY, NM, TN and WA.

This form is required and allows one or more representatives of the employer to access the Self Service website.

Miscellaneous Underwriting Forms

Affidavit - Committed Domestic Relationship
Committed Domestic Relationship affidavit for use with Allied group medical and dental plans
Affidavit - Participating Business Owner
A Participating Business Owner must use this Affidavit to certify eligibility to participate in an Allied Group Plan on the same basis as an eligible employee.

Formas en Español (Spanish Forms)

Allied No Médico Formulario de Inscripción del Empleado
Employee Enrollment Form.


Looking for Something Different?

Download brochures, applications, and other resources for all Allied plans. Use these materials to present plan options to your clients.

If you are unable to find what you're looking for, please contact Allied Client Services.
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CONTACT US

Allied National
4551 W. 107th St. #100, Overland Park, KS 66207-4037


Sales Support  888-767-7133 sales@alliednational.com 
Client Services  800-825-7531 clientservices@alliednational.com   

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© 2021 Allied National, LLC. All Rights Reserved.
  • Home
  • Employers
    • Self-Service Login
    • Prescription Benefits
    • Lab Program
    • Abenity
    • Employer Resources
    • EBA Newsletter
  • Members
    • Member Connection
    • Member Resources
    • HealthCare Assistant
    • HealthChoices
    • Self-Service Login
    • Find A Provider
    • Prescription Benefits
    • Telehealth
    • Lab Program
    • Abenity
    • Member Download Forms >
      • Compliance
    • Member FAQs
  • Agents
    • Agent Edge
    • Plans >
      • Level Funding >
        • Freedom Plan >
          • Traditional
          • Essentials
        • PPO
        • Cost Saver Plan
        • Preventive Minimum Essential Coverage
        • Direct Primary Care >
          • DPC Directory
      • Dental Design
      • Pivot Health Individual Plans >
        • Short Term Medical
        • The Bridge to Medicare
        • Fixed Indemnity
        • Brilliant Dental
      • Premium Only Plan
    • Self-Service Login
    • Download Forms - Agents
    • Product Availability
    • Training Webinars
    • Agent FAQs
  • About Us
    • History
    • Testimonials
    • Blog
    • Newsroom >
      • Allied Logos
  • Contact Us