Enrollment Form

If your browser is set up to use Acrobat Reader, you can download our enrollment form here. Then print the form, complete and sign it and return it to us:

Altus Dental Insurance Company, Inc.
PO Box 1557
Providence, RI 02901-1557

Otherwise, click below to download a copy of Acrobat Reader free from Adobe.

Enroll Now Benefit Summary Rates and Information How the Plan Works Commonly Asked Questions