EFD Dental Membership Plan

• Two cleanings, exams, x-rays per year
• Significantly reduced dental fees
• No annual maximum or deductibles
• No pre-authorizations
• No wondering what insurance will pay towards your treatment
• Immediate eligibility - no waiting periods

This is NOT dental insurance. Enrolling in the EFD Membership Plan gives you the opportunity to receive your dental treatment exclusively at our practice for reduced fees. It cannot be combined with dental insurance or other reduced fee dental plans.

 Monthly Membership Dues - $40 initial enrollment fee, if paid out monthly

• Adult Member: $24 ($288 annual total)
  Includes: Cleaning (2 per year), Periodic Exam (2 per year), Bitewing x-rays (1 per year),  Panoramic x-ray (1 every 3 years), Emergency Exam (1 per year)
  All other treatment excluding cosmetic (botox and filler) - 15% off

 

• Adult Perio Member: $36 ($432 annual total)
  Includes: Cleaning (3 per year), Periodic Exam (2 per year), Bitewing x-rays (1 per year), Panoramic x-ray (1 every 3 years), Emergency Exam (1 per year)
  All other treatment excluding cosmetic (botox and filler) - 15% off

 

• Child Member (ages 0-13): $21 ($252 annual total)
  Includes: Cleaning (2 per year), Periodic Exam (2 per year), Bitewing x-rays (1 per year), Panoramic x-ray (1 every 3 years), Emergency Exam (1 per year)
  All other treatment excluding cosmetic (botox and filler) - 15% off

Terms and Limitations of the Plan

• This is a dental discount plan and is NOT dental insurance. It cannot be combined with any other dental insurance. 
• The effective date of this plan is the day you sign the agreement, and the automatic renewal date is 1 year after the agreement date.
• Please notify the office at least 2 weeks before the renewal date to cancel.
• Exams, x-rays, and cleanings must be performed within the year of enrollment and cannot be carried over to the next year.
• Payment is due at the time of service for any work not covered 100% by this plan.
• Payment of less than the plan's duration membership fees may result in being charged usual and customary fees for all services (including those already provided) and being charged remaining months' fees in a lump sum.
• This plan is only accepted at Efird Family Dental. Therefore, if you are referred to a specialist, they will NOT offer these discounts.
• Should there be dental treatment needed following any type of injury where a lawsuit, and therefore outside medical, care, disability, or workers comp type insurances are involved, this discount plan cannot be used.
• This plan is non-transferrable. Family members cannot be substitutes for another family member. 
• This plan is non-refundable. No refunds are given if a patient chooses not to use their dental plan after the first 30 days following enrollment.
• Eligible for dental services only, products are not included.
• A fee may be incurred for each broken appointment without a 24-hour advance notice.
• Rates are subject to change annually.

Credit Card Auto Draft Agreement

I authorize Efird Family Dental to run my credit/debit card number:

If this card declines, then I authorize Efird Family Dental to run this credit/debit card: