Suit Your Smile - Pick The Membership Plan That Suits YOU! (Webpage)

Exclusive Benefits:

4 Plan Options to suit your needs:

*Patient Promise Guarantee - if you aren’t happy with anything about your membership or care in our office, simply give us a call, and Dr. Williams will ensure your concern is made right. It’s our promise to you!

Choice of bonus daywhite refill or extra SPRY rinse/paste at renewal when renewed on or before last day if Membership from previous year.

30 day guarantee - will refund difference for 30 days from today if unsatisfied for any reason. Plus No lab fees apply!

Act Now, To Get Your FREE Spry HomeCare System. We Have Limited Memberships Available This Month...100% No-Risk, Satisfaction GUARANTEE!

Bonus Selections - Includes 1 Year Membership - limited to next 19 who enroll this month!

By signing here I agree to stated terms and condition listed above. I acknowledge this membership is good for exactly 1 full year from today.

Patient Name ________________________   Date __________     Signature of Patient or Legal Guardian________________________

*Initial fee is refundable for a full 30 days from signed date of this agreement, if you’re not satisfied, just let us know and we’ll be happy to give your money back (but we know you’ll love this plan)!  Plan is nontransferable to another party.  Patients agree that Pinecrest Dental fees stated must be paid at the time services are rendered.  Plan fees are valid only when paid at the time of enrollment, and only valid at Pinecrest Dental.  This is not an insurance product. Cannot be used with any insurance or other offers. Discounts only apply to payment in full prior to treatment.

Renewal option: Choice of bonus daywhite refill or extra SPRY rinse/paste when you renew before your yearly plan expires!

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