Proceed Dental Saving Plan

The Proceed Dental Saving Plan is a solution for those who do not currently have dental benefits or feel that their current benefits are insufficient. Our plan provides an affordable, hassle-free way for you and your family to receive the dental care you need. We want you to take care of your teeth in order to achieve a healthy and long-lasting smile, and we believe that our membership plan can help facilitate a lifetime of consistent dental care.

Patient Name:

Last *
First *
Phone *
Email *
Address: *
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Membership expires 1 year from this date, unless renewed:


This program is a discount membership, not a dental insurance, and is secondary to any other dental insurance. It cannot be used as follows:

  • In conjunction with other memberships or discounted dental insurance plans.
  • Not valid for any dental office promotions or discounted services.
  • This plan is non-transferrable, family members cannot be substituted in for another family member.
  • Treatment for dental injuries covered by workmen's comp, disability insurance, lawsuit, or outside medical care are not covered under this plan.
  • For treatment done outside the dental office.
  • For referrals to specialists.
  • For hospitalization or hospital charges of any kind.
  • For IV sedation or General Anesthesia services.


  • The 12-month membership is due in full upon enrollment.
  • Membership is effective on the day on which the full payment is received
  • It is the sole responsibility of the member to maximize benefits by arranging the appropriate appointments within the 12-month membership period. If appointments are not used, the member will not be entitled to a refund.
  • Renewal payment is due at the beginning of each month of the original joining year.
  • With recurring (auto-renew) memberships, the member’s credit card on file will automatically be charged on renewal date.
  • There will be a $50 reinstatement (late) fee if your membership lapses.
  • 10% will be added to membership fee if it is paid by third party financing.
  • Membership rates may be reviewed and adjusted on an annual basis.
  • Payment is due when services are rendered, otherwise discount is void!
  • During 30 days grace period and before using your membership, you can receive a full refund. In the case that a member decides to get a refund after services have been rendered, a refund will be issued minus the FFS value of those services rendered.

I have read and agree to the Membership Rules & Terms Of Payment.

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