Dental Plan Registration

Begin your dental plan registration by filling out the form below.

Once completed, you will finish your registration at the office where someone will help you choose the plan right for you, and your billing will start.

Krider Dental Wellness Center

You will choose one of these dental plans when you finish your registration in the office.


Plan Name Monthly Yearly

Adult Plan

2 Exams, 2 Cleanings, 2 Fluoride treatments, 1 Set of bitewing x-rays, 1 Periapical x-ray, 1 Panoramic x-ray (every 5 years), Oral hygiene instruction, Annual periodontal charting, 15% Off on all other treatment. One-time enrollment fee of $100 for all new patients.
$35.00/ mo $420.00/ yr

Child Plan

2 Exams, 2 Cleanings, 2 Fluoride treatments, 1 Set of bitewing x-rays, 1 Periapical x-ray, 1 Panoramic x-ray (every 5 years), Oral hygiene instruction, Annual periodontal charting, 15% Off on all other treatment. One-time enrollment fee of $50 for all new patients.
$31.00/ mo $372.00/ yr

Perio Plan (3 visits)

2 Exams, 3 Periodontal maintenance cleanings, 1 Fluoride treatment, 1 Set of bitewing x-rays, 1 Periapical x-ray, 1 Panoramic x-ray (every 5 years), Oral hygiene instruction, Annual periodontal charting, 15% Off on all other treatment. One-time enrollment fee of $100 for all new patients.
$48.00/ mo $576.00/ yr

Perio Plan (4 visits)

2 Exams, 4 Periodontal maintenance cleanings, 1 Fluoride treatment, 1 Set of bitewing x-rays, 1 Periapical x-ray, 1 Panoramic x-ray (every 5 years), Oral hygiene instruction, Annual periodontal charting, 15% Off on all other treatment. One-time enrollment fee of $100 for all new patients.
$60.00/ mo $720.00/ yr

Dental Plan Members

Who is signing up for a dental plan? We only need basic information for now; you will choose a plan for each member and begin your billing when you visit our office.

Members

First Name * Last Name * Date of Birth *

Billing Details

Once your registration is complete and your plan is approved, how would you like to be billed?

Note: This card WILL NOT be charged until you visit the office to select a dental plan and finalize your registration. We collect this information now to speed things up during your first appointment!

Credit Card Information

This card will be used for all members associated to this responsible party.

Card Number
Please enter a valid Credit Card number
Expiration (mm yy) Example: 06 27

Ready to submit?

Please Correct all errors marked in red in your registration information and submit again

When you’re finished, click the button below to submit your information. You will not be billed until you choose a plan and finalize your registration at our office.