Wellness Dental Plan Registration

Two regular cleanings and exams plus necessary x-rays per patient per calendar year.
Save 25% on all other dental procedures including additional x-rays, emergency exams, fillings, root canals, crowns, dentures and implants.

Members must use our network of dental practices.

This program is a discount plan, not a dental insurance plan. It cannot be used in conjunction with dental insurance.

Plan will automatically renew each year at anniversary sign up date

Configure Your Plan

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Customer Information

First Name *

Last Name *

Email Address *

Phone

Organization

Billing Information

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First Name on Account *

Last Name on Account *

Card Number *

CVV

Expiration Month *

Expiration Year *

Billing Address

Address 1

Address 2

Billing Country

Billing City

Billing State

Billing ZIP Code

Additional Information

Date of Birth

Office Location

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Recurring Fee (every 12 months)	$700.00
Today's Total	$700.00
then $700.00 at first renewal on 11 Sep 2027