Utah Dental Plan

Dental Discount Plan

Basics

Our dental discount plan allows you and your family to receive quality dental services at Quarry Bend Dental at substantial savings. It allows us to provide great dental care and eliminate the prohibitive cost of semi-annual exams and cleanings and give you a discount on your comprehensive dental needs. We feel that prevention is key and that by receiving regular care we can decrease the possibility of higher cost dentistry.

In a Nutshell

Low annual fee
$10 exams, $10 x-rays, $10 basic cleanings
40% discount on most procedures
No Annual Maximums
No Deductibles
No Pre-existing conditions
No waiting period
This is a dental discount plan that is available for dental discounts.

Mutually Beneficial

*YOU SAVE MONEY

*WE GROW OUR BUSINESS

We are willing to give you a substantial discount on our fees. In return, you help us grow into a very successful practice. We both benefit.

MISSION STATEMENT:

We are committed to do everything in our power to ensure that any procedure performed in our office:

*Looks Good

*Lasts a Long Time

*Is Comfortable and Feels Good

Most importantly we want you to know that you are the boss.

FEE SCHEDULE

	Usual,Customary and Reasonable Fee	Discount Plan Fee
Filling (2 surface)	$196	$117
Root Canal (molar)	$1007	$604
Crown (all porcelain)	$1116	$669
Extraction (simple)	$150	$90
Implant	$1850	$1100
Bleaching	FREE	FREE
Denture	$1650	$990

Examples:

Exam, X-rays and basic cleaning:
Without discount plan $303
With discount plan $30
Save $273

Root Canal, Build-up and Crown:
Without discount plan $2343 With discount plan $1404 Save $939

10 extractions and upper and lower dentures:
Without discount plan $4800
With discount plan $2880Save $1920

Dental Limitations and Exclusions

Procedures performed at Quarry Bend Dental are limited to those that the dentist is comfortable performing. Exclusions may include oral surgery such as setting fractured jaws, removing malignancies, procedures performed in the hospital, general anesthesia and any procedure the dentist feels should be completed by a specialist.

*THIS IS NOT A HEALTH INSURANCE POLICY. *A HEALTH/DENTAL DISCOUNT PLAN MEMBER IS RESPONSIBLE FOR THE ENTIRE PAYMENT OF THEIR MEDICAL OR HEALTHCARE BILL AFTER THE DISCOUNT IS APPLIED. *SERVICES UNDER DISCOUNT PLAN ARE ONLY PROVIDED AT QUARRY BEND DENTAL BY GREGORY J RANDALL. LIMITATIONS AND EXCLUSIONS APPLY.

Annual Cost of Discount Plan

Family of 1	Family of 2	Family of 3	Family of 4 or more
$150	$250	$350	$450

Payments:
*Annual payment must be made.

Who is eligible?
YOU! There are no restrictions to individual plans. Family is defined as you and your spouse along with any dependent children under the age of 23.

When am I eligible?
NOW! NO WAITING PERIODS. Eligibility starts when financial arrangements have been made.

Obligations:
Ours: As always, we are committed to providing quality dental services to the best of our ability
Yours: None. As we require the annual fee upfront and it is only an annual commitment, there is no further obligation. We do hope you see the benefit and continue on a year to year basis, but there is no obligation.

Cancellation:
We offer a 30-day money back guarantee on any annual dental discount plan fee. This 30-day period begins once payment has been made. If you cancel after the initial 30-day period and before a total of 12 months, you are responsible for the UCR fees on all previously performed procedures. For dispute resolution or to cancel, simply call or come into the office.