Enrollment Instructions

If you would like to enroll in one of our individual plans, please follow the instructions below or send a request to have an application be sent to you:

     1. Download and print an application form. Download

         the benefits summary (optional) or benefits detail (optional). 
     2. Complete the enrollment application
     3. Include a check or credit card payment, payable to the

         California Dental Network, for your premium and the

         one-time, non-refundable enrollment fee.

     4. Mail the application and check to:
         California Dental Network
         1971 E. 4th Street, Suite 184
         Santa Ana, CA 92705-3917
We must receive your application before the next deadline for your coverage to begin on the first day of the following month.

Use the above program if you have trouble downloading application.