Request Confidential Communications

You have the right to reasonably request to receive confidential communications of your PHI.

To request confidential communication, complete the <Confidential Communication Form> below:

First Name

Last Name

Address (line 1)

Address (line 2)

City

State

Zip Code

Phone

Email Address

Alternate Mailing Address

Alternate Phone Number

Alternate Means of Contact (please specify)

Please only click Submit once

You may also submit your request in writing to privacy@libertyhealthplan.com or by the contact methods below:

Our contact details
Contact address	Privacy Officer LIBERTY Dental Plan 1730 Flight Way, Suite 125 Tustin, CA 92782
Contact email address	privacy@libertydentalplan.com
Contact fax number	888.273.2718
Contact telephone number	888.704.9833

Compliance and Privacy Links: