This is NOT a dental insurance, rather a membership plan. This membership serves as an exclusive agreement between our patients and our practice. This plan is only valid at this dental office. Plan fees are subject to change. 

• 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.

• Plan Services Included: (1) periodic exam, (1) comprehensive or periodic exam, (1) limited exam & PA, (1) prophylaxis (routine cleaning), (2) oral cancer screenings, (2) fluoride Varnish applications, 4 bitewings, 1 Panoramic or full mouth x-rays. 15% off services (excluding products).

• Plan Price and Service Charges: The dental office reserves the right to adjust monthly fees, services, and the terms and conditions of this agreement as of the date of the renewal of this agreement.

• Cancellation: Member has the right to opt out of plan for full refund if treatment (i.e. exams & more) 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.

• Payments: 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. Monthly payment options are available with a $75 enrollment fee and a 20% surcharge will be applied to each month of enrollment.

• Overdraft: An overdraft/re-processing fee of $30 will be billed to you for insufficient funds, over limit status, or any other reason a payment is unable to be processed based on the account information supplied by you. Member is responsible for immediately notifying the dental office of any changes in billing account information to avoid any payment reprocessing fees. The dental office reserves the right to withhold service if your account is not current. This membership is an exclusive relationship between your dental office and yourself. Smile Advantage LLC is in no way financially responsible for any member’s treatment cost, refunds, charge backs or additional fees.

• Default: In the event you fail to pay any monthly installment on or before its due date, the dental office has the option to immediately cancel this agreement or discontinue plan services and declare all remaining monthly installments for the then current plan period to be immediately due and payable. After 30 days, your account may be referred to a collection agency. Collection activity may negatively impact your Credit Bureau information. If the dental office permits you to restart a plan after cancellation, a new enrollment fee will be required unless special arrangements are made between you and the dental office and agreed to in advance in writing.

• Collection Costs: If you fail to make any payment when due under this agreement, you shall pay the collection costs, whether or not a legal action is commenced. In the event of any legal proceeding (including appeals and bankruptcies), the prevailing party shall be entitled to recover its costs, disbursements and reasonable attorneys’ fees as determined by the court.

• Entire Agreement: This agreement constitutes the entire agreement between the dental office and you concerning the subject matter hereof. You warrant that you have not relied upon any promise or representation not set forth expressly in this agreement. This agreement may be amended and provisions of this agreement may be waived, only by a signed written agreement.

• Choice of Law: Jurisdiction: This agreement shall be governed and construed in accordance with the law of the state or commonwealth where the dental office facilities are located, and the courts of that state or commonwealth shall have exclusive jurisdiction over any claim or dispute concerning the interpretation or enforcement of this agreement. Each party consents and agrees that such courts shall have personal jurisdiction over such party.

• Severability: If any provision of this agreement is determined by a court of competent jurisdiction to be unenforced, the remaining provisions of this agreement shall remain in full force and effect.

• Further Assurances: As a condition to Provider’s obligation to provide services to you under the plan, you shall execute and deliver consents, limitations, or waivers of liability, arbitration provisions, or any other documents as the dental office may from time to time request of its clients in the normal course.

• Unused Plan Benefits: 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.

• Missed Appointments: The dental office reserves the right to charge a missed appointment fee if any scheduled appointment is missed without 48 hours notice.

By enrolling in the 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 Beyond Dental of Gulf Breeze upon enrollment. I authorize this dental office to process my payment as listed in this agreement.