Skip survey header

DentaSeal Edits 2022

DentaSeal Edit Request, F-02366 (11/2018)

This form is for DentaSeal users to request changes to data that has already been entered in DentaSeal. Any personal health information entered in this form will be securely transmitted to the Wisconsin Department of Health Services Oral Health Program. Any questions about using this form should be submitted to dhssealasmile@dhs.wisconsin.gov.