Lifestyle Dental Plan

Membership runs on a calendar year:
All Membership must be paid in advance.
10% all products to members
15% off all unlisted fees.

EXAMS AND X-RAYS: NO CHARGE
Single Member: $125
(Children under 16 yrs. $75.00, Under 5 yrs $50.00)
Couple: $225
Family (up to 5 members) $325
Senior Plan 50 yrs +: $97

Terms and Conditions

LIFESTYLE DENTAL PLAN

March 30, 2009

By signing below, I understand that I am enrolling myself and any designated dependents into Lifestyle Dental Plan. I acknowledge that Lifestyle Plan is an exclusive program unique to Hitzel Dental and can only be used for services at a Hitzel Dental office. I understand that Lifestyle Plan is a discount dental plan and is NOT A REGISTERED DENTAL INSURANCE PLAN. As a result, I will incur out-of-pocket expenses which are due to the provider at the time services are rendered.
I also understand the dentist(s) I select as my provider(s) may not perform all of the services listed on the fee schedule. I authorize the dentist who renders services to me, or members of my family under the Lifestyle Plan, to make available to George E. Hitzel, D.D.S.,PA. my dental records, photocopies or information regarding such services to the extent permitted by law. I understand that once my enrollment fee is paid in full, I am immediately eligible to receive Lifestyle benefits.
Terms and Conditions. Services are provided subject to my compliance. My continued use of this site indicates that I agree to be bound by the Terms and Conditions of Use. George E. Hitzel, D.D.S, P.A., may revise and update the Terms and Conditions of Use at any time. It is my responsibility to review the terms, conditions, and privacy statements posted on the Hitzel Dental website each time I enter the site. Continued use of the Hitzel Dental website or Hitzel Dental will be considered as acceptance of any changes to the Terms and Conditions. Certain provisions of the Terms and Conditions may be superseded by expressly designated legal notice or terms on particular pages at this site.

1. Binding Agreement. Electronic information. I hereby consent to the exchange of information and documents electronically over the Internet or by e-mail, and I understand that this electronically displayed information shall be the equivalent of a written paper agreement. I have the right to receive this agreement in non-electronic form and I may request a non-electronic copy of this agreement either before or after I accept the terms of this agreement. To receive a non-electronic copy of this Agreement, please contact us at.

2. Billing. I also agree to pay Hitzel Dental all charges pursuant to the fee schedule in effect at the time of service for any dental services provided under the Lifestyle Dental Plan. I acknowledge that individual procedure prices on the Lifestyle Dental Plan are reviewed or amended annually, or more frequently, as needed, or as new services or procedures become available. George E. Hitzel, D.D.S.,P.A., reserves the right to correct any errors or mistakes that may have been made on billing, even if Hitzel Dental has already requested or received payment.

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