Annual Program FeesSingle $250

Each additional family member $150

The program is a discount program, not a insurance plan.

It Cannot Be Used:

• In conjunction with any form of dental insurance plan• For injuries covered under any other insurance plan• For treatment, which, in the sole opinion of the our dentist, lies outside the realm of their capabilities• For referrals to specialists• For hospitalization or hospital charges of any kind• For immediate eligibility• At any other dental office

Program Guidelines• This plan is only honored at Clock Tower Dentistry• Discounts cannot be used in conjunction with any other dental plan or discount program• These fees are Non-Refundable• No refunds offered for underutilization of the program• Patient’s portion of the bill is due at the time of service• Your plan’s effective date will be on file with our office

How To Sign Up

Please ask one of our friendly front desk team members for an application or visit our website atwww.ClockTowerDentistry.com and choose“Contact Us”

The Clock Tower Dentistry Savings Program is designed to make excellent, high quality dentistry affordable and to provide greater access to dental care.

• No yearly maximums

• No membership cards

• No deductibles

• No claim forms

• No pre-existing condition limitations

• No waiting periods

• Free Consultations

How It Works

Program Benefits

The Annual Program Fees are based on family members living in the same household.

Exclusions & Limitations

DENTAL DISCOUNTS

X-Rays:Examinations:

Preventative:Child Prophylaxis (2 per year)

Adult Prophylaxis (2 per year)

(Does not include periodontal treatment)

Additional Cleanings per year

Fluoride Treatments (2 per year)

Sealants

All Other Procedures:Fillings & Core Buildups

Crowns & Bridges

Veneers and Bonding

Dentures & Partials

Oral Surgery

Periodontal Treatment (deep cleanings)

Root Canals

Night Guards

Orthodontics (Invisalign only)

Teeth Whitening

100%

100%

100%

100%

20%

100%

20%

20%

20%

20%

20%

20%

20%

20%

20%

10%

$99