Maddox Dentistry
Dental Membership Plan

THIS PROGRAM IS NOT INSURANCE

The program is only offered to individuals and families not currently covered by a dental health/insurance plan or Medicaid.  This plan is not subject to any Maximums, Deductibles, or Waiting Periods.  (If a patient is found to be covered by a dental insurance plan that Maddox Dentistry is a participating provider for, membership is no longer valid and the insurance plan fees, payments, and deductibles apply.)

The program outlined herein is only valid at Maddox Dentistry and benefits are not transferrable to another dental or specialty practice. 

Basic Membership

($47 per person per month ($564) or $533 if paid Annually)

INCLUDED:    

• Any xrays required at preventive visits
• 2 Cleanings and 2 Exams (Including VelScope screening) 
• Fluoride treatments as needed
• 50% discount for sealant placement
• 15% discount on all other services

(Orthodontic, Botox, and Dermal Filler services are excluded)

Enhanced Membership

($73 per person per month ($876) or $835 if paid Annually)

INCLUDED:    

• Any xrays need at preventive visits
• 2 Cleanings and 2 Exams (Including VelScope screening)
• Fluoride treatments and sealants as needed
• 1 included Emergency visit with necessary xrays
• 20% discount on all other services, except as noted below
• 10% discount on Orthodontic, Botox, and Dermal Filler services

Ideal Membership

($101 per person per month ($1212) or $1145 if paid Annually)

INCLUDED:  

•  Any xrays needed at preventive visits
• 2 Cleanings and 2 Exams (Including VelScope screening)
• Fluoride treatments and sealants as needed.
• 2 included Emergency Visits and necessary xrays
• 30% discount on all other services, except as noted below
• 15% discount on Orthodontic, Botox, and Dermal Filler services

MADDOX DENTISTRY MEMBERSHIP PLAN APPLICATION FORM

Program Guidelines 

1. This program is NOT insurance. The program is only offered to individuals and families not currently covered by a dental health/insurance plan or Medicaid. This plan is not subject to any Maximums, Deductibles,
   or Waiting Periods. [If a patient is found to be covered by a dental insurance plan that Maddox Dentistry
   is a participating provider for, membership is no longer valid and the insurance plan fees, payments, and deductibles apply. ]
2. The program outlined herein is only valid at Maddox Dentistry and benefits are not transferrable to another dental or specialty practice. Membership benefits cannot be combined with any other offers or discounts. Payment arrangements for membership fees are due at time of enrollment and must be up to date to receive membership benefits. Payment arrangements for the patient’s portion of services provided are due at the time of service.
3. Membership is for 1 year from time of enrollment and shall automatically renew on the anniversary date unless a written request to cancel is received 30 days prior to renewal. Membership fees, fees for services, and terms of agreement may be altered at the discretion of Maddox Dentistry at renewal. Any changes in this regard, including a notice of renewal, will be communicated with the member 30-60 days prior to renewal. Membership fees are non-refundable. In addition, no refunds will be given if a member does not use the plan, relocates, or obtains dental insurance coverage.
4. 48 hour notice is preferred, 24 hour notice required, if a member needs to cancel or reschedule an appointment. There is a $100 cancellation fee for each appointment that is missed or cancelled with less than 24 hours notice. Three (3) “no-shows” or cancellations without 24 hour notice may lead to membership termination without refund.

TERMS OF MEMBERSHIP (including treatment discounts) apply to services actually performed/received during the membership plan year. These terms do not apply to services diagnosed/treatment planned during
a membership year that are performed later during a year for which a membership agreement has not been completed and payment arrangements made for. Regular fees shall apply to those services, unless membership participation is reconciled.