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AffordableDental CoverageFor You & Your Entire Family
Low-Cost Dental Coverage
As Low as $16.58/mo.
Join 32 Perfect Dental Care’s In-House Premier Dental Coverage
• All Health Conditions Accepted!
• You Cannot Be Denied Coverage!
• No Deductibles!
• No Health Questions!
• You Cannot Be Singled Out for Rate Increases or Cancellations!• Comprehensive Exam
(once every six months)
• Fluoride for Children (under the age of 18, once every six months)
Our Affordable Coverage Includes the Following Services at No Charge:
• X-Rays (once every 12 months)
• Cleaning (Prophylaxis) (once every six months)
1. Child’s First Name _________________________ Middle Initial ______________ Son / Daughter Date of Birth ______________________________
2. Child’s First Name _________________________ Middle Initial ______________ Son / Daughter Date of Birth ______________________________
3. Child’s First Name _________________________ Middle Initial ______________ Son / Daughter Date of Birth ______________________________
4. Child’s First Name _________________________ Middle Initial ______________ Son / Daughter Date of Birth ______________________________
Complete This Form toBegin Coverage Today
8422 East Shea Boulevard, Suite 104Scottsdale, AZ 85260
480-315-1044
ID# 5837 © December 2016 chrisad, inc., marin co., ca all rights reserved.
Enroll Today!
As Low as $16.58/mo.
We’re Making Excellence in Dentistry Affordable for You!
Please List All Unmarried Kids Up to Age 20
We are located on East Shea Boulevard, in the Sundown Ranch office park.
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Patients agree that 32 Perfect Dental Care fees stated must be paid at the time services are rendered. Any service not paid for at the time of service will be billed at usual & customary fees. Coverage fees are valid only when paid at the time of enrollment. All family members must reside in the same household. This is not an insurance product. Membership renews annually on the day & month of initial enrollment. Membership renews automatically unless member formally requests otherwise in advance.
Make check or money order payable to 32 Perfect Dental Care.
Complete This Form to
Begin Coverage Today!
First Name ________________________________________
Last Name ________________________________________
Middle Initial ________________________ Female / Male
Home Address _____________________________________
__________________________________________________
City _____________________ State ______ Zip ________
Phone ____________________________________________
Email _____________________________________________
Date of Birth _____/_____/_____ S.S.#_____-_____-_____
Spouse Name ______________________________________
Middle Initial ________________________ Female / Male
Date of Birth _____/_____/_____ S.S.# _____-_____-_____
Enrollment Period _______________ to _______________
Signature (member & spouse)
__________________________________ Date ___________
__________________________________ Date ___________
American Express / Discover / MasterCard / Visa
Card Number ______________________________________
Expiration Date ____________________________________
Low-Cost Dental Coverage• Individual ~ $199/yr.• Individual & Spouse ~ $299/yr.• Additional Child ~ $60/yr.
Now you can join our low-cost dental coverage for a nominal membership fee. Our coverage entitles you to preventive dental care at no cost! Corrective services are available for small co-payments that are far less than the usual, customary fees. Our professional staff is qualified to care for all of your dental needs!
To enroll, simply fill out the enclosed enrollment form & return it with your check, money order or credit card information. Please make check or money order payable to 32 Perfect Dental Care.
Examination . . . . . . . . . . . . . . .No Charge . . . . . . . . . . . $94
X-Rays (every 12 months) . . . . .No Charge . . . . . . . . . . $117
4 Bitewing X-Rays . . . . . . . . . .No Charge . . . . . . . . . . . $67(every 12 months)
Adult Cleaning . . . . . . . . . . . .No Charge . . . . . . . . . . . $98(every six months)
Children’s Cleaning . . . . . . . . .No Charge . . . . . . . . . . . $71(every six months)
Fluoride Treatment . . . . . . . . .No Charge . . . . . . . . . . . $24 for Children (every six months)
Preventive Dentistry
Service Co-Payment“Basic Care”
Regular Feesas High as
Soft Tissue Management . . . . . . . $100 . . . . . . . . . . . . $264(per quadrant)
Periodontal Maintenance . . . .No Charge . . . . . . . . . . $147
Periodontics
Service Co-Payment“Basic Care”
Regular Feesas High as
Invisalign® . . . . . . . . . . . . . . . . . $4,200 . . . . . . . . . . $5,145(financing available as low as $99/mo. after down payment)
Nightguard . . . . . . . . . . . . . . . . . . $463 . . . . . . . . . . . . $579
Orthodontics
Service Co-Payment“Basic Care”
Regular Feesas High as
Emergency Exam . . . . . . . . . . .No Charge . . . . . . . . . . . $78
In-Office Teeth Whitening . . . . . $179 . . . . . . . . . . . . $199
Sealant (per tooth) . . . . . . . . . . . . .$25 . . . . . . . . . . . . . . $49
Sealants . . . . . . . . . . . . . . . . . . . . .$39 . . . . . . . . . . . . . . $49
Other Treatments
Service Co-Payment“Basic Care”
Regular Feesas High as
Affordable Dental Coverage for the Whole Family!
8422 East Shea Boulevard, Suite 104Scottsdale, AZ 85260
480-315-1044Please Inquire About
Services Not Listed Here!
1-Surface Filling . . . . . . . . . . . . . . $155 . . . . . . . . . . . . $194
2-Surface Filling . . . . . . . . . . . . . . $198 . . . . . . . . . . . . $248
3-Surface Filling . . . . . . . . . . . . . . $243 . . . . . . . . . . . . $304
4-Surface Filling . . . . . . . . . . . . . . $335 . . . . . . . . . . . . $419
Crown . . . . . . . . . . . . . . . . . . . . . $1,062 . . . . . . . . . .$1,328
Crown Buildup . . . . . . . . . . . . . . . $219 . . . . . . . . . . . . $274
Root Canal–Anterior . . . . . . . . . . $595 . . . . . . . . . . . . $743
Root Canal–Molar . . . . . . . . . . . . $882 . . . . . . . . . . .$1,103
Denture–Top . . . . . . . . . . . . . . . $1,500 . . . . . . . . . .$1,875
Denture–Bottom . . . . . . . . . . . . $1,358 . . . . . . . . . .$1,697
Restorative Dentistry
Service Co-Payment“Basic Care”
Regular Feesas High as
