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Loyalty Program Registration Form

For our patients without insurance, we’ve launched our Loyalty Program to simplify payments for preventative care. 
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    • Afghanistan
    • Albania
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    • American Samoa
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    • Argentina
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    • Netherlands
    • Netherlands Antilles
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    • Philippines
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    • Qatar
    • Republic of the Congo
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    • Russia
    • Rwanda
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    • Saint Helena
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    • Trinidad and Tobago
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    • Tunisia
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    • British Virgin Islands
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    1. Membership clubs are not insurance but a payment arrangement provided by David J. Stinchfield, PC for services rendered.

    2.  Memberships are provided exclusively to uninsured patients of our practice and shall not be considered pre-payment for future services or payment for access to discounted services. Rather, our patient members are electing to make regular monthly subscription payments for preventive care instead of paying at the time of each service.

    3. Payment for any cosmetic or restorative treatment is due at the time of service.

    4. Membership dues must be current in order to receive services. A lapse of 28 days in dues will require a reactivation fee of six months’ dues.

    5. Membership club discounts may not be combined with any other offers or discounts.

    6. It is solely the patient’s responsibility to schedule and keep their appointments. 

    7. No refunds will be provided for dues paid under any circumstances, including failure to schedule and maintain appointments.

    8. A patient member’s monthly agreement is with the legal entity of David J. Stinchfield, PC.

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    Please reach out and read our Privacy Policy in order to understand how your information is used and shared, and check below if you accept the policy.

    By using the Discovery Dental Loyalty Program, you agree to accept our Terms of Service and Privacy Policy.  This Privacy Policy describes, among other things:

    • Personal and other information we collect about you
    • How we use your information
    • How we may share your information with third parties
    • Your choices regarding the personal information we collect about you

    David J Stinchfield PC ("Discovery Dental") understands that you care about the security of your health and personal information. At Discovery Dental, we take these matters very seriously and adhere strictly to HIPAA (Health Insurance Portability and Accountability Act of 1996) and its implementing regulations, which provide data privacy and security guidelines for safeguarding medical information.


    Discovery Dental collects information only to share it with your provider and care team to enable them to provide you with dental care.


    Discovery Dental doesn’t share or sell your information to third parties.

     

     

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    Once you submit your application, we will contact you shortly to complete your membership application.  Thank you!
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