Child Membership Plan

$250/Year

One emergency exam with x-ray per year
15% off all additional regularly priced services
10% off all additional regularly priced services when paid with Care Credit or Lending club
Discounts exclude orthodontic services such as Invisalign

15% off all additional regularly priced services
10% of all additional regularly priced services when paid with Care Credit or Lending club
Discounts exclude orthodontic services such as Invisalign

Adults

2 Routine cleanings per year
2 Routine oral exams per year
Full mouth series x-rays
Panoramic x-ray every 3-5 years as needed
1 Fluoride Treatment per year
One emergency exam with x-ray per year
15% off all additional regularly priced services
10% of all additional regularly priced services when paid with Care Credit or Lending club
Discounts exclude orthodontic services such as Invisalign

Children:

2 Routine cleanings per year
2 Routine oral exams per year
Bitewing x-rays
Panoramic x-ray every 3-5 years as needed
1 Fluoride Treatment per year
One emergency exam with x-ray per year
15% off all additional regularly priced services
10% of all additional regularly priced services when paid with Care Credit or Lending club
Discounts exclude orthodontic services such as Invisalign

This membership plan is not dental insurance and is only offered to patients who do not have dental insurance.
Benefits cannot be used with dental insurance or with other discount offers.
This plan is not transferrable any other dental office, therefore if you are referred to a specialist, discount will not apply.
Payments for additional dental services are the member’s responsibility.
Payment is due on the date of service to qualify for the discounts detailed above.
Membership must be current to receive the discount. Fees for dental services may change at any time.
It is the member’s responsibility to schedule and keep all appointments offered as part of the dental program.
Please notify our office at least 48 hours in advance if you must change a scheduled appointment.
Dental services only, does not include products.
Monthly amounts will be automatically deducted the first day of the month.
Membership fee will be prorated if patient is signing up during the middle of the month.
Benefits are not transferable to other family members or friends.
No credit will be given to unused benefits.
Benefits cannot be used to cover injuries or conditions under Workers Compensation, State Disability plans.

Monthly membership can be cancelled at any time
There is $100 cancellation fee, if membership is cancelled within the first 3 months.
A 30 day written notice to the office is required to cancel membership.
Membership fees are non-refundable.
Upon cancellation, if there is any pending or uncompleted dental care, patient must pay the full non-discounted amount for the dental service provided.

Termination Conditions:

Procedure Description	Non-Member Fee	Member Fee	Membership Savings
New Patient Exam	$98	$0	$98
6 Month Routine Checkup	$55	$0	$55
Adult Healthy Mouth Cleaning	$100	$0	$100
Child Healthy Mouth Cleaning	$78	$0	$78
Emergency Exam	$65	$0	$65
Fluoride Treatment	$52	$44	$8
Sealants	$67	$57	$10
Periodontal Maintenance	$153	$130	$23
Routine Extraction	$209	$178	$31
1 Surface Composite Filling	$191	$162	$29
Single Crown Full Porcelain	$1,600	$1,360	$240
Root Canal Front Tooth	$995	$846	$149
Root Canal Molar	$1,195	$1,016	$179

*Fees are subject to change