Formulaire

Dental-facial orthopedic treatment - Request for prior agreement dentist

Cerfa 10518*01 (S3150)

  • Public concernéInsurance policy
  • CoûtService free
  • Nombre d’étapes3 steps
  • LangueLanguage French

Fill out the form

Comment faire ?

  1. Have filled the form by the dental surgeon
  2. Sign the form
  3. Send the form at the dental check of your health insurance fund
General scheme
Who shall I contact
Agricultural scheme
Who shall I contact

Et après ?

The cash register's response must be addressed no later than day 15 following receipt of the form. Failure to reply within that period shall constitute an agreement.

Treatment must be started within 6 months following the date of the take-over agreement.

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Verified 30 January 2026 - Public Service / Directorate of Legal and Administrative Information (Prime Minister)