Request Your Dental, Vision & Hearing Quote
Fill out the quick form below to get your personalized Dental, Vision & Hearing (DVH) insurance options. We’ll compare multiple carriers to find the best plan for your needs and budget — no obligation, no spam.
Contact Information
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Preferred Contact Method
Please Select
Phone
Email
Text
Back
Next
Location & Household
Zip Code
*
State
*
Who needs coverage?
Just me
Me + spouse/partner
Me + child(ren)
Whole Family
Names & Dates of Birth for Everyone Needing Coverage
Back
Next
Dental, Vision & Hearing Needs
Dental Services Most Important to You:
Preventive care (cleanings, exams, X-rays)
Basic services (fillings, extractions, periodontal)
Major services (crowns, root canals, dentures)
Orthodontics
Vision Services Most Important to You:
Annual eye exams
Eyeglasses (frames + lenses)
Contact lenses
Lens enhancements (anti-reflective, photochromic, progressive)
Discounts on LASIK/PRK
Hearing Services Most Important to You:
Hearing exams
Hearing aids (behind-the-ear, in-the-ear, rechargeable, etc.)
Device adjustments/fittings
Repairs or replacements
Back
Next
Coverage Details
When do you want coverage to start?
-
Month
-
Day
Year
Date
Preferred providers? Include dentist, eye doctor, or hearing care provider names
Monthly Budget for DVH Coverage
Please Select
Under $30
$30-$50
$51-$75
$76+
Back
Next
Additional Information
Do you currently have coverage for the following? (select all that apply)
Dental
Vision
Hearing
Any upcoming procedures you want covered?
Comments or special requests
Back
Next
Consent & Submission
*
I agree to be contacted by Peterson Insurance Solutions regarding my quote request.
Get My Quote
Should be Empty: