Dental Insurance Pre-Authorization Request Form

Getting insurance pre-authorization for dental procedures doesn't have to be a paperwork headache. This Dental Insurance Pre-Authorization Request Form template helps dental practices submit clear, complete pre-auth requests to insurance carriers—reducing back-and-forth, speeding up approvals, and keeping your schedule on track.

Built for dental offices, periodontists, oral surgeons, and orthodontists, this form captures everything insurers need: patient demographics, insurance details, treating provider information, procedure codes with descriptions, cost estimates, and supporting documentation like X-rays and clinical notes.

Why dental practices choose Paperform

Paperform makes it easy to create professional, on-brand forms that work the way your practice does. Upload your logo, match your colors, and embed the form on your website or share it directly with patients and referring providers. File upload fields let patients or staff attach X-rays, photos, and treatment plans securely, and conditional logic shows only the fields you need based on the procedure type.

Once a pre-auth request is submitted, Paperform can automatically send confirmation emails to your front desk and route submissions to your practice management system via integrations with tools like Zapier, Make, or Stepper—your AI-native workflow builder. Use Stepper to trigger follow-up tasks, update patient records, or notify your billing team when approval comes through.

Need a signature on a treatment consent form after pre-auth is approved? Use Papersign to turn submissions into eSignature-ready documents and close the loop without printing a single sheet.

Whether you're a solo practitioner or a multi-location practice, this template gives you a faster, more organized way to manage insurance pre-authorizations and keep your team focused on patient care.