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This Dental Services Membership Agreement (the “Agreement”) is entered into on the Commencement Date (as defined below) by and between Practice (as defined in Exhibit A), and the Patient as listed below; and with the Practice and the Patient also each referenced herein as a “Party” and collectively as the “Parties”.

WHEREAS, the Practice is a subscriber to TruBlu Plan For Health, LLC Oral Wellness Membership Program software as a service platform (“TruBlu Software”)

WHEREAS, the Practice utilizing the TruBlu Software has created specific oral wellness membership programs to offer its patients (“Programs”);

WHEREAS, the Patient desires to participate in one of the Programs and engage the Practice to provide dental services for the Patient under the terms of this Agreement;

WHEREAS, the Patient has selected the Program that includes the dental services and/or benefits which he/she will be provided by the Practice (the “Dental Services”) from the Programs offered in the Practice’s instance of the TruBlu Software Platform included in this online enrollment process;

WHEREAS, based on the Patient’s Program selection(s) the TruBlu Software has calculated the Membership Fee (as defined below), and the Patient has completed the payment requirements as required through the secure portal on this website; and

WHEREAS, the Patient desires to enter into this Agreement as the terms and conditions under which the Dental Services will be provided by the Practice through the Program;

1. Incorporation of Recitals. The recitals are incorporated as substantive provisions of this Agreement.
2. Dental Services. During the Membership Period, (as defined below), the Practice will provide the Patient those Dental Services he/she has selected from the menu of available Programs included in this online enrollment process.
3. Complications. Patient acknowledges his/her understanding and acceptance that with any dental procedure there are “known and accepted complications”; that is, a difficulty or problem with the procedure which arises in a certain percentage of cases even when the procedure is performed correctly. The Patient acknowledges that if such a complication arises with the Practice’s providing of any of the Dental Services, the Practice may charge an additional fee, in addition to the Membership Fee, to treat the complication. The Practice may also refer the Patient to a dental specialist who is not a participating provider in the Program and who will charge the Patient a fee for this specialist’s treatment of the complication.
4. Scheduling; Practice Rules & Procedures. The Patient is responsible for scheduling his/her appointments to take advantage of the Dental Services provided by the Practice under the Program. Please contact the front desk by phone or use the Practice’s website to schedule an appointment where applicable.

The Practice has established certain rules as its standard operating procedures (e.g.; cancellation and rescheduling of appointments; timing, and method of payment for any treatments/services not included in the Dental Services; emergency protocols; and COVID-19 infection control measures). These procedures are included on this website, and a paper copy of them will be provide to the Patient upon his/her first appointment. The Patient must comply with them as a condition of continued enrollment in the Program.

5. Changes in Dental Services & Program Options. During the Membership Period no changes will be made in the Dental Services. However, at the conclusion of each Membership Period the Practice reserves the right to alter, change, add- to, subtract- from, or delete any of the Dental Services the Practice will provide in any renewal of this Agreement

The various treatments\services which the Practice provides through the Program, as listed in the menu, may be altered, changed, added - to, subtracted- from, or deleted at any time, including but not limited to, at the time of any renewal of this Agreement, without prior notice to the Patient.

6. Exclusions. If an individual is already a patient of the Practice when they enroll in the Program, then any treatments/services they received prior- to, and any which they are in the mist- of receiving at the Commencement Date, are excluded from the Plan. The Practice will provide, or will continue to provide, as applicable, these treatments/services under its usual, customary, and reasonable fee schedule then in effect.

If during the Enrollment Period the Patient requests that the Practice provide any treatments/services which are not include in the Dental Services, and the Practice does provide them, they will be charged according to its usual, customary, and reasonable fee schedule then in effect.

Dental Services which are begun but are not completed as of the Termination Date will be continued under the Program after the Termination Date; but only if the Patient renews this Agreement for another Enrollment Period. If the Patient does not renew, then the completion of these Dental Services will be according to the Practice’s usual, customary, and reasonable fee schedule then in effect.

Dental Services which the Patient does not utilize by the Termination Date cannot be carried over with any renewal of this Agreement for a successor Membership Period. The Patient will not receive a refund of any portion of the Membership Fee for any Dental Services which the Patient does not utilize prior to the Termination Date.

7. Exclusive Use. This Program is non-transferable by the Patient to any other person.
8. Membership Fee. The Membership Fee is the amount listed for the Membership Period based on the Dental Services selected by the Patient. The Membership Fee is non-refundable. The Fee applies only to the Dental Services provided by the Practice, and it does not apply to any other dental treatments/services provided by the Practice or by any other Dental provider, including any specialty dentist to whom the Practice may refer the Patient for treatment/services.
9. Term. The term of this Agreement shall begin on the date that the Patient completes the enrollment process (the “Commencement Date”) and shall continue for a term of 365 days thereafter (the “Membership Period”). The 365th day being the “Termination Date.”
10. Termination & Renewal. This Agreement shall automatically terminate on the Termination Date. At that time, the Patient may renew his/her membership in the Program through this enrollment process under the terms and conditions the Program is then offering through its Dental Services Membership Agreement then in effect.
11. Termination by Practice. The Practice reserves the right to terminate the Patient‘s enrollment for any substantial failure to comply with the terms of the Program or the Practice’s standard operating rules and procedures; or if the patient is noncompliant with the Practice’s clinical instructions /directives or otherwise is noncompliant; or if the patient is disruptive or otherwise inappropriate in his\her conduct. The Practice will refund the Patient a prorated amount of the Membership Fee based on the amount of Dental Services the Practice has provided for the Patient at the time of such a termination. The Practice will charge the Patient for these Dental Services according to its usual, customary, and reasonable fee schedule then in effect. If these charges are in excess of the Membership Fee, then the Patient will be charged for any amount in excess.
12. Questions\Concerns. If the Patient has any questions or concerns about any aspect of the Program, they can submit them to the Practice by contacting (via email or through the practice’s website.)
13. Disclaimer. This Program is not insurance and is not intended to replace dental insurance. It is not a Qualified Health Plan under the Affordable Care Act. The Program and the Practice are not licensed insurers, health maintenance organizations, or other underwriters of health care (dental) professional services. The Program, itself, does not make any payments to the Practice, only the Patient makes such payments. There is no collective risk between and among the individuals who become Practice patients under the Program. Each patient has his/her own separate account with the Practice and the Membership Fee of each patient is strictly used to compensate the Practice for the Dental Services it provides for the individual patient.
14. Entire Agreement & Amendments. This Agreement constitutes the entire understanding between the Parties with regard to the Patient’s enrollment in the Program, and it supersedes any prior oral or written agreements\understandings between the Parties with regard to the Program This Agreement may be amended only by a writing executed by both Parties.
15. Assignment of Agreement. Because this Agreement is for the personal professional services of the dentists at the Practice, it is not assignable by the Practice to any person or entity. Because this Agreement is personal to the Patient, it is similarly not assignable by the Patient to any other person or entity.
16. Governing Law and Jurisdiction. This Agreement shall be subject to, and governed by, the laws of the State in which the Practice is located, and the Parties agree to the exclusive jurisdiction of the state courts in the county in which the Practice is located. Both Parties agree to the exclusive jurisdiction and venue of these courts for any claims, complaints, causes of legal action or other controversies which arise between them under this Agreement and under any and all other professional and personal dealings/relationships between them.
17. Severability. If any provision of this Agreement is held to be unenforceable for any reason, its unenforceability shall not affect the remainder of this Agreement, which shall remain in full force and effect and enforceable in accordance with its terms.
18. Additional Terms, Exclusions, and Disclosures. Can only be used at this location. Perio Protect discounted at 10% only

I have read, understand, and knowingly agree to, and will comply with, all the terms and conditions of this Agreement. I acknowledge that my participation in the Program is strictly voluntary.