Dental Society Employer Questions

Please answer the questions, and upload a copy of your most recent billing statement, then click the save button at the bottom of the page as it will email your answers directly to our team.


1. Dental Practice Name?
2. Dental Practice Address?
3. Dental Practice Phone Number?
4. Dental Practice Email?
5. Dental Practice Administrative Contact Name?
6. Dental Practice Administrative Contact Number?
7. Dental Practice Administrative Contact Email?
8. Dental Practice Business Type?

9. Do you offer a group health plan?

10. Do you offer HSA/HRA/FSA?

11. Do you reimburse employees to be on their spouses health insurance plans?

12. Do you offer any other benefits outside of health insurance? (Please list other benefits offered)
Import Dental Society Document
Copyright 2019 by Secure Enroll Inc