Dental Savings Plan Agreement
Sign up for our in-house Dental Savings Plan and enjoy quality care at affordable rates. Review the terms below and complete the form to enroll.
Terms and Conditions
1. Term of Agreement
This Prepaid Dental Service Program (the "Agreement") by and between Perfect Smile Dental Care (PSDC) and Patient shall be for a term of one (1) year commencing on the date of the last party to execute this Agreement (the "Term"), and shall automatically renew at the end of the Term for another yearly term unless either party provides written notice to the other party of its intention to terminate the Agreement at least thirty (30) days before the end of the Term.
2. Dental Services Provided by PSDC
PSDC shall provide the following dental services ("Dental Services") to the Patient in accordance with the terms of this Agreement:
a. Two (2) routine teeth cleanings or periodontal maintenance (excludes SRP), per Term of twelve (12) months.
b. Two (2) oral examinations per Term of twelve (12) months.
c. Two (2) sets of routine x-rays per Term of twelve (12) months, including 4 bitewings and 3 PA x-rays.
d. One (1) emergency examination per Term of twelve (12) months, including problem-focused exam and necessary x-rays.
e. $500 off Comprehensive Invisalign Treatment.
f. Twenty (20%) percent discount on all other dental services provided by PSDC to Patient and not outlined in subsections a) through e) above, excluding any Orthodontic Services, Cosmetics, Certain Specialized Services, and take-home dental products. For purposes of this Agreement, Orthodontic Services shall include, but not limited to, active appliances, adjustments of the appliances, and any and all x-rays or oral examinations associated with the same; Cosmetics Services shall include, but not limited to, bioclear, veneer, whitening, etc.
The parties agree that PSDC may delegate Dental Services to any of PSDC qualified individually licensed dentists to perform the Dental Services, subject to the continued oversight and supervision of PSDC.
3. Fees for Services
Patient agrees to pay PSDC in exchange for the Dental Services, a one-time nonrefundable enrollment fee of Seventy Nine and 00/100 ($79.00) Dollars (the "Enrollment Fee") at the time of execution of this Agreement. Additionally, Patient shall pay monthly installments of Forty Nine and 00/100 ($49.00) Dollars (the "Monthly Installment") for adult or Twenty Four and 00/100 ($24.00) Dollars for child for twelve months. The one-time nonrefundable enrollment fee of Seventy Nine and 00/100 ($79.00) will be waived for patients that elect to pay a one-time Annual Payment in full for the amount of Five Hundred Eighty Eight and 00/100 ($588.00) Dollars for adult or Two Hundred Eighty Eight and 00/100 ($288.00) Dollars for child (the "Annual Payment"). For purposes of this Agreement, adult is for patients who are 12 and above years old, and child is for patients who are under 12 years old.
The patient shall sign an Authorization Agreement for recurring payments authorizing PSDC to charge a credit card or debit card designated by the patient in the amount of the monthly or annual installments. The form of such Recurring Payment Authorization is attached hereto as Exhibit A, and incorporated herein by reference (the "Recurring Payment Authorization Form").
The patient's payments must be current to receive the services and discounts included in the membership plan.
4. Default and Termination
Either party may terminate this Agreement upon written notice to the other party in the event of a material default under the terms of this Agreement. In the event of a material default, the breaching party shall have fifteen (15) business days from receipt of written notification of the default to cure such default to the reasonable satisfaction of the non-defaulting party before such termination shall become effective. Upon any termination by PSDC under this Section 5, all remaining Monthly Installments due after the date of such termination shall become immediately due and payable in full, and this Agreement and all rights and obligations created hereunder shall be deemed null and void and of no further force or effect.
5. Relocation
In the event Patient permanently relocates his or her principal residence more than forty five (45) miles from the office location of the PSDC, Patient may terminate this Agreement by providing written notice of such relocation to PSDC at least thirty (30) days before Patient's requested termination date of this Agreement (the "Termination Date"). Commencing on the Termination Date, this Agreement and all rights and obligations created hereunder shall be deemed null and void and of no further force or effect.
6. PSDC’s Termination
PSDC reserves the right without the consent of the Patient to terminate this Agreement for any reason whatsoever, including, but not limited to, death or disability of the PSDC Dentist, sale of the dental practice where Dental Services under this Agreement are rendered, or relocation of PSDC. Upon any termination by PSDC under this Section 7, all rights and obligations created hereunder shall be deemed null and void and of no further force or effect.
7. Notices
Any notice required or permitted to be given under this Agreement shall be given in writing and deemed given on the date it is sent by certified mail, postage prepaid, return receipt requested, to PSDC, at the address set forth above, and in the case of the Patient, at the address set forth above. In the event of any change in the address of Patient, it shall be the responsibility of Patient to notify PSDC in writing of such change(s) as set forth above.
8. Entire Agreement
This Agreement, including any schedules and exhibits attached hereto, contains the entire agreement between the parties and supersedes any prior or contemporaneous agreements between the parties. It may not be changed orally, but only by an agreement in writing, duly signed by the party against whom enforcement of any waiver, change, modification, extension, or discharge is sought; provided, however, PSDC retains the unilateral right to change the terms of this Agreement after the end of the first Term.
9. Not an Insurance Contract
This is a direct contractual agreement for dental services between PSDC and an individual patient. The Perfect Smile Dental Savings plan is not an insurance plan and will only cover dental services provided within Perfect Smile Dental Care.
10. Governing Law
This Agreement shall be governed and construed in accordance with the laws of the State of California without regard to conflict of law principles.