Dentist Services / Prior Approvals

Dear Dentist Service Providers,
Please be aware complete the missing details as in beneficiary card.
Please complete the data missing for English Only.
All attached downloads must be Original and Clear.
Sincerely!

Select Action Dentist*

Governorate*

Branch / Area*

Type Of Service*

Date Of Visit Clinic*

Date Of Visit Clinic

Date Of Service*

Date Of Service

Value Of service*

Endurance Ratios*

Beneficiary's Card*

Beneficiary's National ID*

Physician Prescriptions*

Swagrass Form

Beneficiary's Phone Number*

You've already responded.

You can submit this form only once.

You've already responded.