Dental Health Savings Plan $225

Freeman Dental - Mayfield

Please correct the errors described below.

The dental health savings plan includes:

  • Two Exams (During your cleaning)
  • Two Regular Cleanings
  • Panoramic X-ray
  • One set of Bitewings X-rays
  • Any P.A. X-rays needed

The exam and cleaning must be set for every 6 months. Any periodontal treatment needed is offered at a discounted rate. This plan is only valid using cash, credit card, or check. (Care credit can only be used if we charge you standard rates.)

Discounted Treatment

20% of the following services:

Limited Exam, Fluoride Varnish, Sealants, Fillings, Extractions, Periodontal Scaling and Root Planing, Full Mouth Debridement, Periodontal Maintenance, Endodontic Therapy, Therapeutic Pulpotomy, Space Maintainer, and Teeth Whitening

10% of the following services:

All Dentures and Partial treatment, Crowns, Implants, Bridges, and Occlusal Guards

Your savings plan will be good for one year and this will start the day you purchase the plan. Freeman Dental, PLLC is not responsible for making sure you have made all your scheduled appointments, this is fully the patient's responsibility. It is best to schedule your appointments in advance due to our schedule filling up very quickly. I understand the dental health savings plan is only good for one year and cannot be carried over to the next year. If you fail to use the plan you will not be refunded for any unused treatment. I have read and understood all material listed above.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

Your information will be encrypted.