Children (Ages 12 and Under)
$16.50 Monthly($41.66 due at signing)*
Adults (Ages 13+)
$25 Monthly($50 due at signing)*
*Initial payment includes $25 setup fee. Payments deducted from a credit/debit card. No cash payment.
Traditional dental insurance stops covering these at about 16 years old, but here at The Good Dentist, we want you to be healthy and use them for a lifetime.
Terms and Conditions
You must remain in the plan and pay membership fees for a minimum of 12 months. Payment of less than 12 months’ membership fees may result in you being charged usual and customary fees for all services (including those already provided) and being charged remaining months’ fees in lump sum.
Fees for dental services are due as services are rendered. I agree to auto renew my membership plan with the dental practice each year for a 12 month term on the anniversary of the plan. If I wish to cancel I will send a written letter/email of cancellation.
Fees for prosthodontics and cast restoration services are due at the preparation/impression visit. Failure to comply may result in my being charged usual and customary fees for such services.
Minor Services are defined as any direct composite or alloy restorations as defined by Current Dental Terminology [CDT] codes D2110-D2394. Major services include but are not limited to any other CDT codes including crowns, fixed partial dentures, extractions, dental implants, orthodontics.
You must agree to pay any and all costs in collecting all charges. Including but not limited to attorney fees and court costs. Coverage must be continuous. Missing monthly payments must be made up for interrupted coverage. Last month fees are not refundable.
DENTAL LIMITATIONS AND EXCLUSIONS
1) Demonstrated non-compliance with recommended course of treatment.
2) Services which in the opinion of the attending dentist are neither necessary nor recommended for the patient’s dental health.
3) Dispensing of drugs not normally supplied in a dental office.
4) Services for injuries or conditions which are covered under Worker’s Compensation or Employer’s Liability laws.
5) General anesthesia/Conscious Sedation
6) Services that cannot be performed because of the general health, physical or psychological limitations of the patient.
7) Plan Participants cannot have other dental coverage.
Please wait while you are redirected to the right page...