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VIP Family (2+ People) - Yearly


One-Time Fee:  $0.00

Plan Price:  $0.00

Total Charged Today:  $0.00


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1. Billing Contact
2. Add New Members
3. Terms and Conditions
4. Billing Sumary and Card Information

Plan Details

VIP Family (2+ People) - Yearly


One-Time Fee:  $0.00

Plan Price:  $0.00

Total Charged Today:  $0.00


Totals will update as members are added to your plan

Terms and Conditions

Discount Medical Plan
This Agreement, referred to herein as the “VIP Plan” or the “All Smiles Dental Discount Medical Plan” is effective as of today’s date, and is made by and between the patient and Kaibab, PC d/b/a All Smiles Dental, a professional corporation organized and existing in North Dakota, with a single office located at 714 S. 2nd Street, Bismarck North Dakota 58504 and a telephone number of 701-258-3308.

OVERVIEW
The Discount Medical Plan is a plan that provides discounts at All Smiles Dental for dental services and is not an insurance plan. The Patient has the sole responsibility of maximizing their benefits in a 12-month period, which commences at the signing of this Agreement (“Subscription Term”). Unused benefits will not be refunded or carried over into a new billing year. This VIP Discount Medical Plan is non-transferable and can only be used at All Smiles Dental in Bismarck, North Dakota.
Membership includes a limited scope of dental services as set forth in this Agreement. The Patient is financially responsible for all services not specified in this Agreement. All Smiles Dental will provide to Patient the dental services identified during Patient’s Enrollment Period. Patient may request a copy of the services provided by All Smiles Dental at any time. Upon request, All Smiles Dental will provide Patient a printed copy of the services.
Patient shall be responsible for paying for all included services, as set forth in this Agreement, at the signing of the Agreement. Patient acknowledges the All Smiles Dental will NOT submit an invoice to the Patient’s insurance for any services provided under this Agreement.

SERVICES
All included services are by appointment only and are offered at the sole discretion of the Provider. Patients with new or existing Periodontal disease will need the VIP Perio Plan for the appropriate level care. The Perio Plan includes all of the services and discounts of the individual plan plus an additional four (4) periodontal maintenance cleanings.

DISCOUNT SERVICES
In addition to the discounted costs for included services, Patient has the right to receive 20% off dental fillings, sealants, and core buildups. The Patient also receives 10% off crowns, veneers, dentures, and partials. The patient receives a flat discount of $500 off Invisalign and $100 off teeth whitening.

EXCLUDED SERVICES
The Patient is responsible for payment of all other services not covered under this Agreement.

PAYMENT
Payment as set forth in the below fee scheduled shall be paid by Patient at the signing of this Agreement. All Smiles Dental will bill the Patient annually on the anniversary date of Patient’s enrollment. The Subscription Term shall renew at the end of the prior Subscription Term unless Patient notifies All Smiles Dental of an intention to cancel. Such notification must be given to All Smiles Dental prior to the expiration of the then-current Subscription Term.
All Smiles Dental reserves the right to change the Subscription Fee or applicable charges and to institute new charges at the end of the then current Subscription Term upon notice to Patient, and upon written modification to the Agreement.

CANCELLATION AND CANCELLATION NOTIFICATION This agreement can be cancelled by Patient at any time. If cancellation occurs within thirty (30) days of the Patient receiving written notification of these cancellation rights, which Patient acknowledges said receipt at the signing of this Agreement, All Smiles Dental shall provide a full refund to the cancelling Patient, exception for a nominal fee associated with the enrollment cost up to a maximum of $50.
A Patient can cancel his or her enrollment in this Agreement by sending written notification to All Smiles Dental, 714 S. 2nd Street, Bismarck, North Dakota 58504.

This is a legally binding agreement made in accordance with Chapter 26.1-53 of the North Dakota Century Code. If Patient has any questions regarding this Agreement, he or she should consult with their legal representative.

I accept the terms and contitions above.


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Plan Signup Progress

1. Billing Contact
2. Add New Members
3. Terms and Conditions
4. Billing Sumary and Card Information

Plan Details

VIP Family (2+ People) - Yearly


One-Time Fee:  $0.00

Plan Price:  $0.00

Total Charged Today:  $0.00


Totals will update as members are added to your plan

Billing Summary and Card Details

Billing Summary

One-Time Fee:  $0.00

Plan Price:  $0.00

Total Charged Today:  $0.00

Next Payment Date:  NA

Next Payment Amount:  $0.00


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Plan Signup Progress

1. Billing Contact
2. Add New Members
3. Terms and Conditions
4. Billing Sumary and Card Information

Plan Details

VIP Family (2+ People) - Yearly


One-Time Fee:  $0.00

Plan Price:  $0.00

Total Charged Today:  $0.00


Totals will update as members are added to your plan