Claims Processing Form We offer you several ways to fill out and submit your claims request form. Each column represents a Nadent office. Simply select the appropriate branch and click on the submission method you prefer.

|  Submit Form by FAX  |  Submit Form by EMAIL  |

NADENT / EAST NADENT / SOUTH NADENT / WEST 355 Main Street Islip, NY 11751 Tel: 800-632-3444 Fax: 631-581-2772 claims@nadent.com 333 West Drake Rd. Suite 21 Fort Collins, CO 80526 PO BOX 270430 Fort Collins, CO 80527-0430 Tel: 800-632-3334 Fax: 970-206-9958 nadentsouth@nadent.com 333 West Drake Rd. Suite 21 Fort Collins, CO 80526 PO BOX 270430 Fort Collins, CO 80527-0430 Tel: 800-367-7390 Fax: 970-226-0249 nadentwest@nadent.com

SUBMIT CLAIMS FORM BY FAX

NADENT / EAST NADENT / SOUTH NADENT / WEST Option 1 Print out Claims Form, fill it out then fax to our office at 631-581-2772. Click here for Option 1. Option 2 Fill out the Claims Form online, print it out, then fax to our office at 631-581-2772. Click here for Option 2. Option 3 Download Claims Form in MS-Word .DOC format, fill it out, print, then fax to our office at 631-581-2772. Click here for Option 3. Option 1 Print out Claims Form, fill it out then fax to our office at 970-206-9958. Click here for Option 1. Option 2 Fill out the Claims Form online, print it out, then fax to our office at 970-206-9958. Click here for Option 2. Option 3 Download Claims Form in MS-Word .DOC format, fill it out, print, then fax to our office at 970-206-9958. Click here for Option 3. Option 1 Print out Claims Form, fill it out then fax to our office at 970-226-0249. Click here for Option 1. Option 2 Fill out the Claims Form online, print it out, then fax to our office at 970-226-0249. Click here for Option 2. Option 3 Download Claims Form in MS-Word .DOC format, fill it out, print, then fax to our office at 970-226-0249. Click here for Option 3.

SUBMIT CLAIMS FORM BY EMAIL

All email claim requests will be acknowledged. If you have not received
a response from us in a couple of days, please give us a call.

NADENT / EAST NADENT / SOUTH NADENT / WEST Click here to submit Claims Form to Nadent East by email. Click here to submit Claims Form to Nadent South by email. Click here to submit Claims Form to Nadent West by email.

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