NEW! Discount Program
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Individual Dental Discount Program


No Dental Insurance? No Problem.

Hilton Head Dental membership plan has been designed specifically for patients without dental insurance who are looking for affordable dental care. Our membership plans are focused on long-term prevention.

This is NOT dental insurance. There is NO maximum. NO deductible. NO limitations. NO waiting period. This is an annual membership plan that allows individuals and families to receive quality dental care at a discounted fee.

Discount Program

Includes:
  • 2 Examinations
  • 2 Cleanings (Prophylaxis)
  • Preventative digital xrays (FMX every 3 years, bitewings annually)
  • 2 Oral Health screenings
  • 10% off additional treatment


12 Month Membership
only $395


How it works:

  • Plans are paid on an Annual Basis.
  • Your plan starts on the day of your first payment.
  • Complete the Form below to sign-up.

What else should I know?

  • Membership plans are NOT dental insurance
  • The membership cannot be used with dental insurance or other discount offers
  • No credit or refunds will be given even if you choose to not be seen in the covered time frame

What is included in the plan?

  • 2 Examinations
  • 2 Cleanings (Prophylaxis)
  • Preventative digital xrays (FMX every 3 years, bitewings annually)
  • 2 Oral Health screenings
  • 10% off additional treatment
Membership level necessary to maintain dental health is determined by the Dentist at the initial examination and is subject to change if your dental needs change.

Limitations and Exclusions:

  • This membership plan is non transferable
  • Non-Compliance with recommended treatment will terminate membership
  • Excludes services not recommended by this office
  • Excludes any retail products sold by this office
  • After hour Emergency Exams are not covered in this membership
  • Excludes any procedure that is referred outside this office
  • Excludes services provided to cover injuries or conditions under workers Compensation
  • Medications/Prescriptions not covered
  • No credit or refunds will be given even if you choose to not be seen in the covered time frame
  • Subsequent visit must be scheduled before appointment has concluded

Sign Up:

Please complete the form below to signup for the program. Your membership starts when your payment is received.


Patient Info

First Name:
Last Name:
Date of Birth:

Address:

City:
State:
Zip:

Phone:
Email:


Billing Info

Card Number:
Expires:
/
Security Code:
Zip Code:


Agreement & Signature

By submitting this form and providing your digital signature below you confirm and agree to the following: I have read, understand and agree to the above membership policies, including all limitations and exclusions. I understand should I need to cancel my appointment, I will provide 48 hours' notice or will be subject to a $55 cancellation fee. I also understand that should I need to cancel my appointment, Hilton Head Dental is not responsible for rescheduling within the covered time frame if appointments are not available. I authorize Hilton Head Dental to process my card for the annual fee of $395.

Digital Signature:
Please sign your name with your finger or draw with your mouse.

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