Dental Claim Form

To submit a manual claim, complete an insurance Dental Claim Form, attach the original receipts and documents, and mail to the insurer. Remember to keep a copy of all original documents for your records.

The following information is required on the claim form:

Green Shield Canada ID Number: Your GSC ID number begins with your school's three-letter code, followed by your student ID number, and ends in -00.
Example: DSU123456789-00
Surname: Your Last Name (as on file with Douglas College)
First Name: Your First Name (as on file with Douglas College)
Address, City & Province: Your Current mailing address
Email Address: Your current email address
Phone Number: Your current phone number
Company Name: Douglas Students' Union

Mailing instructions are found on the top of the Dental Claim form.

For claims prior to September 1, 2017, please click here.

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Dental Claim Form

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