The Evolve Membership Plan is an annual membership plan that allows individuals and families who do not have Dental insurance to receive quality dental care at a reduced cost.
Evolve Member Plan !!
- Save 15% on dental treatment*
- No waiting periods or maximums
- No insurance hassle
- 1 FREE emergency visit (includes a limited exam / PA)
First Year $575
FIRST VISIT
New Patient Exam
- Comprehensive Exam
- Cleaning
- 4 Bitewing / 2 PA X-Rays
SECOND VISIT
Regular 6 Month Recall
- Periodic Exam
- Cleaning
Every Year After $500
FIRST VISIT
6 Month Recall
- Periodic Exam
- Cleaning
- 4 Bitewing / 2 PA X-Rays
SECOND VISIT
6 Month Recall
- Periodic Exam
- Cleaning
*Excludes Cosmetics, Implant placement, Products & all Orthodontic treatment*
* If using Care Credit to pay for the plan, you will be charged an additional 10%*
* If using Care Credit to pay for any treatment, you will only get a 5% off due to charges*
Initial: ____________________________
Date: _______________________________
Date: ___________________________
Limitations and Guidelines
This plan is non-refundable. No Refunds or premiums will be issued at any time if participant decides not to utilize their dental membership. You will not receive a membership card-your plans effective date will be on file with our office.
THIS PROGRAM IS AN IN-OFFICE DISCOUNT PLAN, NOT A DENTAL INSURANCE PLAN. THIS PROGRAM CANNOT BE USED:
IN Conjunction with another dental plan or offer- For services covered under worker compensation- For treatment which, in sole opinion of the treating dentist, lies outside the realm of their capability- For referrals to specialist- For hospitalization or hospital changes- For cost of dental care which is covered under auto medical. This plan is only covered at the Evolve Dental Care office. It cannot be used at any other office. THIS PLAN IS NON-REFUNDABLE, no refunds or premiums will be issued at any time if participant decides not to utilize dental plan. The 12 -month membership is due in full upon joining. Membership is effective on the day which payment is received. Payment is due when services are rendered. It is the sole responsibility of the member to maximize benefits by arranging the appropriate appointments within the 12 months membership period. If the appointments are not used, the member will not be entitled to a refund. Renewal payment is due the beginning of the same month of original joining each year. Membership rates may be reviewed and adjusted on an annual basis with notification. Membership plan excludes cone beam x-rays.
Financing
Dentistry will never be cheaper than it is today!! And your dental problems will never be cheaper or easier to fix than today!
Give us a call to discuss your options!!
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