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SRP Membership

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Dental Membership Plan Agreement – Healthy Gums

This Membership Plan is designed for patients without dental insurance who have healthy gums.

It is not dental insurance and cannot be combined with dental insurance or other discounts.

(If periodontal disease is present, a Periodontal Membership Plan is required.)

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SRP Membership Benefits (per patient)

  • Comprehensive periodontal exam and diagnosis
  • Full mouth series of X-rays (FMX, as clinically indicated — panoramic not included)
  • 1 full round of Scaling & Root Planing (SRP, usually completed in 2–4 quadrants depending on clinical needs)
  • 1 periodontal re-evaluation exam (approximately 4–6 weeks after SRP)
  • 15% discount on additional periodontal or restorative procedures recommended after SRP
  • Priority scheduling for follow-up care

Terms & Conditions

  1. Membership covers the SRP treatment phase only; once completed, patients may transition to a Periodontal Maintenance Membership Plan for ongoing care.
  2. Membership is valid for up to 6 months from date of enrollment (SRP and re-evaluation must be completed within this period).
  3. Membership fees are non-refundable. No refunds or prorating for relocation, change of providers, or unused benefits.
  4. Membership is non-transferable to another person.
  5. Cancellation/No-Show Policy: Appointments canceled or rescheduled within 48 hours, or missed without notice, will result in loss of that benefit.
  6. Services not completed within the membership period are forfeited.
  7. 15% discount cannot be combined with other promotional offers, coupons, or financing discounts. Discount applies only to treatment completed during active membership.
  8. Membership fee must be paid in full at the time of enrollment.
  9. Not valid with dental insurance, Medicaid, or any other dental coverage.
  10. Our practice reserves the right to adjust fees or benefits annually. Terms may be updated at renewal.

Pricing (per year, per patient)

  • SRP Plan: $999

Acknowledgement & Agreement

I understand and agree to the terms of this SRP (Scaling & Root Planing) Dental Membership Plan.

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