Your Claim Form has been submitted successfully.
HOWEVER, it appears one or more of the documents you uploaded were not successfully received. Please see below for which file(s) had errors and log back in to your existing Claim online to re-upload your document(s). Alternatively, you can send your documents with your Submitted Claim ID to the Settlement Administrator by email to: info@DominionDentalSettlement.com.
Please print this page for your records.
Your Claim Details
|Submitted Claim ID:|
|You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.|
|Mailing Address, Line 1|
|Mailing Address, Line 2|
|Telephone Number (Home)|
|Telephone Number (Other)|
If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at info@DominionDentalSettlement.com
Click here to edit your Claim.