This is NOT dental insurance rather a membership plan. This membership serves as an exclusive agreement between our patients and our practice. This membership plan cannot be used in conjunction with dental insurance or any other discounts. This plan is only valid at this dental office. Plan fees are subject to change.

• For any issues regarding our membership plan, please contact our office directly.

•If you are a current patient enrolling in the Dental Savings Plan, your account MUST have a ZERO balance.

• The plan is not retro-active and will become effective on the date of enrollment.

• It is the member’s responsibility to utilize the services included in this agreement within their plan year limit. Any unused benefits will not be carried over or refunded. The plan is non-transferable.

• In exchange for the care provided under this plan, the covered member agrees to pay all balances in full at the time of treatment. If treatment is not paid in FULL at the time of service, the treatment discount is void.

• The member has the right to opt out of the plan for a full refund within 30 days of enrollment as long as treatment has not started. If ANY treatment has been performed or if 30 days from enrollment have lapsed, NO refund will be given. The member will be responsible for paying the remaining balance regardless of services rendered.

• Services are based upon a plan year. The full membership fee is due on the date of enrollment and eligibility will begin at that time remaining active for one year. Your annual membership will be auto-renewed at the end of each plan year. If your dental practice allows monthly payment options, an enrollment fee and surcharge may be applied.

• This membership is an exclusive relationship between my dental office and myself. Smile Advantage LLC is in no way financially responsible for any member’s treatment cost, refunds, charge backs or additional fees.

• If the membership plan is not utilized within the year, it cannot be carried over to the next year. This means that any unused benefits, such as free cleanings or discounts, will expire at the end of the membership term. Please note that it is important to schedule your appointments in a timely manner to ensure that you receive the full benefits of your membership plan. If you do not schedule your appointments and your membership expires,
you will need to renew your membership to receive the benefits again.

By enrolling in the Dental Savings Plan at this dental office, I acknowledge that I have reviewed, understand, and agree to the terms and conditions of the Smile Membership as presented by dental office upon enrollment. I authorize this dental office to process my payment as listed in this Agreement.