Dento-maxillo-facial orthopedic treatments - Request for prior agreement - Physician (Form 10522*01)

National Health Insurance Fund (Cnam) - Cerfa n° 10522*01
Autre numéro : S3155

Form to be sent to the dental control of your health insurance organization.

The form contains recommendations for use.

Go to the online administrative form

Verified 08 June 2022 - Directorate for Legal and Administrative Information (Prime Minister)

To whom shall I send this form ?

Contact the entity in charge of this form

For details, please use the practical information sheets :

J'ai réalisé une démarche administrative

Je donne mon avis sur Services Publics +. L'administration concernée me répondra.