Florida Healthy Kids Incentive Form

To get your $10 Amazon gift card you must:

Please briefly explain your license request below

While showing active coverage, make sure to have the qualifying dental services:

I had a sealant

Date of service

Yes

Member Information

First Name

Last Name

Date of Birth

Phone

Mailing address

City

Zip code

If you have questions, please call DentaQuest toll free 888-696-9557 TTY 711 or 800-855-2880.

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