MEMBERSHIP PROGRAM DETAILS INCLUDE:

• No Yearly Maximums
• No Deductibles
• No Claim Forms
• No Pre-Authorization Required
• No Waiting Periods
• Up to 15% off any other necessary/diagnosed dental treatment

ALL OTHER PROCEDURES

• Fillings & Extractions up to 15%
• Periodontics & Root Canals up to 15%
• Crowns & Veneers up to 15%
• Dental Implants up to 15%
• Dentures & Partials up to 15%
• Orthodontics/Invisalign Custom Pricing up to 15%

15% Discount if paying by Cash/Check

12% Discount if paying by Credit/Debit Card

*Use of HSA/FSA card are valid towards annual membership and other additional procedures.

Care Credit payments will not be eligible toward annual Dental Membership Plan but can be utilized for additional benefits without further discount.

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 specialists – For hospitalization or hospital charges – For cost of dental care which is covered under auto medical. This plan is only covered at the office of Perry Woo, DDS. 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 on 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-month membership period. If the appointments are not used, the member will not be entitled to a refund. Renewal payment is due at 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 Pano and Cone Beam X-Rays.

By signing this document, I acknowledge that I am agreeing to the chosen Dental Membership Plan, Terms, Limitations and Guidelines as described above.