United Health Care Internal Landing Page

Please fill out as much information as possible.

Agency Name

Preferred Date

Alternative Date #1

Alternative Date #2

Number of Employees

Room Size

Street Address

City

Zip Code

State

Parking Instructions

United Healthcare Rep

Rep Phone Number

Rep Email Address

Security Requirements

Other Details

Additional File Upload

Resources:

Patient Safety and COVID-19 Guidelines: www.jetdental.com/patient-safety/

Jet Dental One Pager:

Your file is downloaded:)

Concerned about COVID-19? Learn more about how Jet Dental prevents the spread of infectious disease.