Wellness Savings Program
Disclaimer: THIS IS A DISCOUNT PROGRAM AND IS NONREFUNDABLE.  Consumer must understand that the Wellness Savings Card was an employee/employer only program that extended their benefits to the individual market and ONLY FREE to the Colonial employee benefit groups as additional benefits to their employees which is payable thru their employer. All applicants will be monitored thru the website if they are not employees of Colonial  employee group enrollment. For more information, please visit our website at https://www.consultwithedmond.com/insurance-brokerage/wellness-dental-and-vision/.
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Name *
Email *
Address *
Phone number *
Family Information
Name, date of birth, and relationship
Family member 1#
Family member 2#
Family member 3#
Family member 4#
Family member 5#
Dentist Name & Address
Sales Tax: 5%. $10 discount for Medicare.
Type of Membership *
Method of Payment *
Card Number
Card Expiration
Billing Zip Code
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