Washington Dental Service Release of Information Authorization Form

The Release of Information Authorization form below is required for the release of dental claims history or benefits information to a personal representative of the patient.

Open the Authorization form here.
Questions? Call Washington Dental Customer Service at (800)554-1907, Monday through Friday, between 8 am and 5 pm PT.
Patients
Individual Plans
WDS is excited to announce that we now offer two plans for individuals and families. Just click here to learn more and enroll!
Go Paperless
Not a WDS member? Prefer to stick with paper? You can have a chance at $10,000! Just print and mail this entry form. No purchase necessary. Restrictions apply. See official rules for odds and other terms and conditions.