Membership Agreement

College Square Dental Wellness Membership Agreement

The College Square Dental Wellness Membership is designed to provide affordability and greater access to quality dental care.  Providing a Wellness Membership Plan is a viable option to conventional dental insurance and the limits that are associated with dental insurance reimbursement, as well as, the disappointing expectations associated with that reimbursement. 

Our plan is simple.  The yearly benefit premium for an Adult is $339.  The premium for a child up to age 12 is $229.  The annual cost covers two cleanings, any cavity detection x-rays and two periodic exams done at the time of the cleanings.  All other procedures are performed at a 20% adjusted rate.  Retail items (i.e. electric toothbrushes, at-home anti-cavity products, periodontal products, etc.) are not adjusted.

Benefits are only available at College Square Dental.  This program is a discount plan and cannot be used in conjunction with conventional dental insurance.  Please refer to the details on the College Square Dental Wellness Membership brochure.

The Dental Wellness Membership fee must be paid in full with cash or check before membership benefits may be used.  Credit card payments for membership dues or treatment will not be accepted.  If the participant does not utilize the Wellness Membership or enrolls in a Dental Insurance plan subsequent to their enrollment in the Wellness Membership Plan, no refunds will be issued or carried over into the next renewal year.  The patient’s portion of any bill is due on the same date the service is rendered.

Participation begins on the date you pay the membership premium and is good for one year from that date.  You will be notified of the renewal date approximately one month before your one-year anniversary date for a new year of participation in the Wellness Plan for the following year.

Download the Agreement Form (PDF) ➔

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