Family Plan Sign-up

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Family

$145.00 / year and a $35.00 sign-up fee

Full-Circle Dental Care Plan for a family.

Cost for Initial Membership: $180

Cost to Renew (if renewed before expiration of your current term): $145

*NOTE –

If you have more than six eligible members in your immediate family – please complete your Family sign-up listing six family members, and then click HERE or visit the Service page to contact our Customer Service department. A representative will reach out to you to add the additional family members to your account.

Account Holder Information (Required)

Account Holder: First Name *

Account Holder: Middle Initial

Account Holder: Last Name *

Account Holder: Email Address *

Account Holder: Birthday *

MMDDYYYY

Account Holder: Phone Number *

Numbers only (e.g. 2815555555)

Add additional family members below.

Note – Family Member 1 is NOT the account holder. It is your first additional family member.

Family Member 1 Information (Required)

Family Member 1: First Name *

Family Member 1: Middle Initial *

Family Member 1: Last Name *

Family Member 1: Birthday

Family Member 1: Relation to Account Holder *

Family Member 2 Information (Optional)

Family Member 2: First Name

Family Member 2: Middle Initial

Family Member 2: Last Name

Family Member 2: Birthday

Family Member 2: Relation to Account Holder

Family Member 3 Information (Optional)

Family Member 3: First Name

Family Member 3: Middle Initial

Family Member 3: Last Name

Family Member 3: Birthday

Family Member 3: Relation to Account Holder

Family Member 4 Information (Optional)

Family Member 4: First Name

Family Member 4: Middle Initial

Family Member 4: Last Name

Family Member 4: Birthday

Family Member 4: Relation to Account Holder

Family Member 5 Information (Optional)

Family Member 5: First Name

Family Member 5: Middle Initial

Family Member 5: Last Name

Family Member 5: Birthday

Family Member 5: Relation to Account Holder

Category: Uncategorized

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© Secure Dent, Inc. 2022 All Rights Reserved
REV.05.01.2022
SecureDent® Dental Savings Program
Terms and Conditions
Secure Dent, Inc. (together with its owners, officers, directors, successors, and assigns hereinafter
referred to as “SecureDent”) administers a dental membership savings program (the “SecureDent
Program”) being offered by one or more independent dentists and/or dental practices (each, a “Dentist”).
These terms and conditions (“Terms”) govern your enrollment and participation in the SecureDent
Program and your use of the SecureDent Program’s online platform (the “Platform”) to enroll in, renew
and administer your membership (the “Platform Services”), including the payment of Membership Fees
(defined below). Enrolling in the SecureDent Program constitutes your acceptance of and agreement to
these Terms and creates a binding agreement between you and SecureDent (the “Agreement”). If you do
not agree to these Terms, do not use the Platform to enroll in the SecureDent Program.
BY ENROLLING IN THE SECUREDENT PROGRAM, YOU ACKNOWLEDGE THAT: THE SECUREDENT PROGRAM
IS NOT AN INSURANCE PLAN AND IS NOT INTENDED TO REPLACE DENTAL INSURANCE. THE SECUREDENT
PROGRAM IS NOT A QUALIFIED HEALTH PLAN UNDER THE AFFORDABLE CARE ACT OR A MEDICARE
PRESCRIPTION DRUG PLAN. THE MEMBERSHIP FEE IS NOT AN INSURANCE PREMIUM. NEITHER THE
SECUREDENT PROGRAM, NOR ANY DENTIST OFFERING THE SECUREDENT PROGRAM, NOR SECUREDENT
ARE LICENSED INSURERS, HEALTH MAINTENANCE ORGANIZATIONS, OR OTHER UNDERWRITERS OF
HEALTH CARE SERVICES. SECUREDENT DOES NOT OFFER OR PROVIDE OR PAY FOR ANY DENTAL SERVICES,
AND NO PORTION OF ANY PROVIDER’S FEES WILL BE REIMBURSED OR OTHERWISE PAID BY SECUREDENT.

SECUREDENT PROGRAM.
As a member of the SecureDent Program (a “Member”), you will receive discounts for certain dental
services at participating Dentists that have contracted with the SecureDent Program. A list of discounted
procedure codes and the then-current fees for those procedure codes, are listed on the Platform
(currently at https://secure-dent.com/sdrates.pdf). The list of discounted procedure codes and
current fees are subject to change from time to time without notice. You are obligated to pay your
Dentist directly for all dental services at the time of your appointment. Savings are based upon the
providers’ usual and customary fees.
• You must be current on your Membership Fees for the SecureDent Program in order to receive
any discounts for dental services.
• You may not combine the SecureDent Program with any other discounts, discount plans, dental
insurance (including Medicare, Medicaid, other forms of government insurance or assistance,
and/or any private insurance plan or policy), or in-office promotion. You agree not to make any
filings with any form of dental insurance plans.
• It is possible that, during the course of treatment by a Dentist, he or she may discover a dental or
health condition, such as periodontal disease, that may require further procedures not included
in the discounted rates shown on the Platform and/or referral to a specialist – the costs associated
with such further treatment and/or specialist are your responsibility.
• Discounts provided under the SecureDent Program apply only to services provided by the Dentist
and not products that the Dentist may sell or services rendered by a dentist other than those
listed on the Platform.
• Any late fees or missed-appointment fees that the Dentist may charge will still apply and will be
your responsibility. You should contact the Dentist regarding any such fees or penalties.
© Secure Dent, Inc. 2022 All Rights Reserved
REV.05.01.2022
• The dollar amount specified adjacent to each procedure may not be the only cost incurred for a
given treatment – many treatments may require more than one dental procedure. Please consult
your Dentist for a detailed treatment plan prior to beginning any work.
• Work in progress prior to joining the SecureDent Program must be completed by the dentist who
started the work and is subject to no discount.
ACCOUNT SIGN-UP; MEMBERSHIP PLANS.
To enroll in the SecureDent Program using the Platform, you must open an account (the “Account”). You
represent that all information you provide during the Account sign-up process, and at any time thereafter,
for yourself and for all family members (collectively, the “Account Information”), will be true, accurate,
complete, and current, and that you will promptly update your Account Information as necessary such
that it is, at all times, true, accurate, complete, and current.
SecureDent will use and maintain your Account Information subject to and consistent with the terms set
forth in our Privacy Policy [www.secure-dent.com/privacy-policy/]. The Agreement incorporates the
terms and conditions set forth in our Privacy Policy. By accessing the Platform and/or participating in the
SecureDent Program, you are consenting to have your personal data and the personal data of your family
members used by us as set forth in the SecureDent Privacy Policy. Without limiting the foregoing, you
further consent to SecureDent sharing your Account Information with any Dentist participating in the
SecureDent Program for the purposes of confirming enrollment and otherwise administering the
SecureDent Program.
To create an Account, you must be 18 years or older and have a unique email address. You will be required
to provide your name and email address and to create a password. To access the Account, the email
address and password will be required. You should not use a generic or shared email address to create
your Account. As the Account holder, you should not reveal the Account Information to anyone else. You
are responsible for maintaining the confidentiality and security of your Account Information and for all
activities that occur on or through the Account.
Your membership in the SecureDent Program will commence upon the submission of a complete
registration form and payment of all applicable Membership Fees. Your initial membership term will be
one (1) year from the date of enrollment. Your membership will not auto-renew, but you may renew the
membership prior to expiration of the then-current term pursuant to Section 5 below.
There are two membership options, an Individual Plan and a Family Plan. An Individual Plan is for a single
individual at least eighteen (18) years of age. The Family Plan is for a single individual at least eighteen
(18) years of age, plus that individual’s Family Members. “Family Members” include the spouse and
children/legal dependents of an individual that the individual could legally have added as family members
on a traditional insurance plan. “Family Members” does not include an individual’s parents, sibling or
other relatives that would not be allowed to be added to a traditional insurance plan if carried by the
individual. If you add someone to your Family Plan membership who does not meet the definition of
“Family Member,” we reserve the right to remove such individual from your membership, and you may
be responsible for paying your Dentist their usual and customary rate for any treatment obtained
before or after removal of such individual from the membership.
© Secure Dent, Inc. 2022 All Rights Reserved
REV.05.01.2022
The type of membership must be selected at the time of enrollment or renewal via the Platform and
cannot be changed mid-term without creating a new Account and paying the fees for an initial enrollment.
(i.e. An individual cannot change to a family membership, or vice-versa, until renewal without creating a
new Account.) In addition, new family members cannot be added to a Family Plan mid-term, but can be
added at the time of renewal. All individuals added to a SecureDent Program membership shall be
considered Members hereunder bound by the terms of this Agreement.
PAYMENT TERMS AND PROCESSING.
SecureDent charges an annual fee for initial enrollment in and renewal of the SecureDent Program (the
“Membership Fees”) as indicated on the Platform. Unless otherwise specified, all fees are in United States
dollars and all charges will be made in United States dollars. Any applicable sales or other taxes are
additional to the stated fee. Membership Fees may be adjusted from time to time and will be published
on the Platform.
SecureDent uses a third-party payment processor to collect and process all payments. In order to make
payments you may be required to agree to the third-party terms and conditions and/or privacy policy.
You are responsible for the timely payment of all fees. You agree that SecureDent may process payment
for all Membership Fees associated with the SecureDent Program that you choose using the payment
method (e.g., credit card, debit card, etc.) that you have provided in your Account Information. We do not
store payment information on the Platform. Therefore, it is your responsibility to provide payment
information in order to renew your membership prior to expiration of your term or to create a new
membership.
You agree not to cause your credit or debit card company to reverse or “chargeback” any fees charged in
accordance with this Agreement; and in the event you do so, we and/or your Dentist may terminate your
enrollment in the SecureDent Program, and you agree to reimburse us and/or your Dentist for any costs
incurred in responding to such chargeback, including, without limitation, our and your Dentist’s actual
costs paid to the credit or debit card company, including chargeback fees, and the value of the time our
and your Dentist’s employees spend on the matter as determined in our or your Dentist’s discretion in
good faith.
LIMITATIONS
Discounts on professional services are not available where prohibited by law. Not all dental services are
discounted under the SecureDent Program. Only those procedure codes specifically listed on the Platform
are provided at discounted prices. If you require any dental services that are not listed, you are responsible
for paying your Dentist for those services at the rates established by your Dentist. You may also be subject
to a Dentist’s late payment fees, no-show or late cancelation fees and other applicable office policies. Any
disputes over the fees charged by dentists must be addressed directly with the Dentist.
Use of the Platform requires compatible devices, internet access, a unique email address, and certain
software; and may be affected by the performance of these factors. You agree that meeting these
requirements, which may change from time to time, is your responsibility. We do not represent or
guarantee you will be able to access the Platform at all times.
© Secure Dent, Inc. 2022 All Rights Reserved
REV.05.01.2022
Your selection of a Dentist is your responsibility and is not based on any representations made by
SecureDent. SecureDent does not guarantee that any particular Dentist will continue to offer the
SecureDent Program for any period of time. In addition, SecureDent reserves the right to change, modify
or make substitutions in the list of participating Dentists at any time, and from time to time, without
notice. Such changes will be reflected on the Platform from time to time. SecureDent will endeavor to
keep the list of Dentists up to date such that only participating active Dentists are listed on the Platform.
SecureDent strongly recommends that you confirm that a Dentist listed on the Platform is currently a
Dentist before you receive any services from that Dentist.
RENEWAL; CANCELLATION; RE-ENROLLMENT.
Your SecureDent Program membership will NOT auto-renew. You have the option to renew your
SecureDent Program membership before expiration of the then-current term by utilizing the Platform to
select your renewal plan and pay the renewal rate, which reflects a discount from the new member rate.
Renewals will not be effective until payment is received.
If you fail to renew your membership prior to expiration of the then-current term, you will be required
to sign up for a new membership at the new member rates instead of the discounted renewal rate.
You do not have any right to cancel your membership in the SecureDent Program before expiration of the
then-current term. You may, of course, choose not to re-enroll after expiration of that term.
REFUNDS.
Except as required by law or otherwise stated on the Platform, and except for bona fide billing errors, all
fees are nonrefundable and payments and purchases may not be canceled by the user. This includes,
without limitation, if you move, change Dentists and/or your Dentist dismisses you from their practice.
COMPLAINTS.
You may submit any complaints regarding the Platform or a billing matter via the Platform [www.securedent.com/service/]; complaints over the telephone cannot be accepted. SecureDent will use reasonable
efforts to respond to your complaint, either by email or regular mail, within fourteen (14) days after it is
received. Because SecureDent is not responsible for the services provided by the Dentists, all complaints
about the dental services provided by the Dentist, the fees you were charged, or any other dissatisfaction
with a Dentist, must be addressed directly with the Dentist.
LIMITATION OF LIABILITY.
ALL SERVICES PROVIDED IN CONNECTION WITH THIS AGREEMENT, INCLUDING, WITHOUT LIMITATION,
THE PLATFORM AND OUR PLATFORM SERVICES ARE PROVIDED “AS IS” WITHOUT ANY WARRANTIES,
EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION ANY IMPLIED WARRANTIES OF
MERCHANTABILITY AND/OR FITNESS FOR A PARTICULAR PURPOSE OR ARISING AS A RESULT OF CUSTOM
OR USAGE IN THE TRADE OR BY COURSE OF DEALING. WITHOUT LIMITING THE FOREGOING, SECUREDENT
AND ITS LICENSORS DO NOT WARRANT OR REPRESENT THAT USE OF THE PLATFORM OR THE PLATFORM
SERVICES WILL RESULT IN COMPLIANCE, FULFILLMENT OR CONFORMITY WITH THE LAWS, RULES,
© Secure Dent, Inc. 2022 All Rights Reserved
REV.05.01.2022
REGULATIONS, REQUIREMENTS OR GUIDELINES OF ANY GOVERNMENTAL AGENCY OR THAT THE
PLATFORM OR PLATFORM SERVICES WILL OPERATE ERROR-FREE OR WITHOUT INTERRUPTION.
IN NO EVENT WILL WE BE LIABLE TO YOU OR ANY THIRD PERSON FOR ANY INDIRECT, CONSEQUENTIAL,
EXEMPLARY, INCIDENTAL, SPECIAL OR PUNITIVE DAMAGES, INCLUDING DAMAGES FOR ANY LOST
PROFITS IN CONNECTION WITH THIS AGREEMENT OR ITS SUBJECT MATTER, EVEN IF WE ARE AWARE OR
HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. CERTAIN STATE LAWS DO NOT ALLOW
LIMITATIONS ON IMPLIED WARRANTIES OR THE EXCLUSION OR LIMITATION OF CERTAIN DAMAGES, SO
CERTAIN PROVISIONS OF THIS SECTION 8 MAY NOT APPLY TO YOU; HOWEVER, THEY APPLY TO THE
GREATEST EXTENT PERMITTED BY APPLICABLE LAW.
NOTWITHSTANDING ANYTHING TO THE CONTRARY CONTAINED HEREIN, TO THE FULLEST EXTENT
PERMISSIBLE UNDER APPLICABLE LAW, THE MAXIMUM AGGREGATE LIABILITY OF SECUREDENT TO YOU,
WHETHER ARISING IN TORT (INCLUDING NEGLIGENCE, BREACH OF STATUTORY OR OTHER DUTY),
MISREPRESENTATION, RESTITUTION, DELAY, FAILURE TO PERFORM, OR OTHERWISE HOWSOEVER
ARISING IN RELATION TO THIS AGREEMENT SHALL NOT EXCEED THE AMOUNTS PAID BY YOU TO US, IF
ANY. TOTAL AGGREGATE LIABILITY ARISING OUT OF OR RELATED TO THIS AGREEMENT WILL NOT EXCEED
THE AMOUNTS PAID BY YOU DURING THE TWELVE (12) MONTHS PRECEDING THE BRINGING OF ANY
CLAIM, OR FIVE HUNDRED DOLLARS ($500.00), WHICHEVER IS LESS. YOU ACKNOWLEDGE AND AGREE
THAT IF YOU HAVE NOT PAID US ANY AMOUNTS IN THE TWELVE (12) MONTHS PRECEDING THE BRINGING
OF ANY CLAIM, YOUR SOLE AND EXCLUSIVE REMEDY FOR ANY DISPUTE IS TO STOP USING THE PLATFORM
AND THE SECUREDENT PROGRAM.
SECUREDENT MAKES NO REPRESENTATIONS REGARDING ANY DENTIST OFFERING THE SECUREDENT
PROGRAM. DENTISTS ARE INDEPENDENT CONTRACTORS AND ARE NEITHER AGENTS OF SECUREDENT
NOR EMPLOYEES OF SECUREDENT OR ITS AFFILIATES. SECUREDENT CANNOT GUARANTEE THE
CONTINUED PARTICIPATION OF ANY DENTIST IN THE SECUREDENT PROGRAM. DENTISTS ARE SUBJECT TO
CHANGE WITHOUT NOTICE AND IF A DENTIST LEAVES THE SECUREDENT PROGRAM, AND YOU WISH TO
CONTINUE PARTICIPATING IN THE SECUREDENT PROGRAM, YOU WILL NEED TO SELECT ANOTHER
DENTIST.
YOUR DENTIST IS SOLELY RESPONSIBLE FOR THE PROFESSIONAL ADVICE, TREATMENT AND CARE, AS WELL
AS THE OVERALL QUALITY OF THE DENTAL SERVICES HE/SHE PROVIDES FOR YOU. NEITHER THE
SECUREDENT PROGRAM NOR SECUREDENT MAKE ANY REPRESENTATION, WARRANTY, OR GUARANTY
REGARDING ANY ASPECTS OF THE DENTAL SERVICES, OR THE QUALITY OR OUTCOME OF SUCH SERVICES
FURNISHED BY DENTISTS. NEITHER THE SECUREDENT PROGRAM NOR SECUREDENT HAS ANY
RESPONSIBILITY OR LIABILITY TO YOU OR ANY OTHER PERSON WITH REGARD TO ANY OF THESE MATTERS,
AND YOU MUST ADDRESS ALL OF THEM SOLELY WITH THE DENTIST.
SECUREDENT DOES NOT PROVIDE DENTAL SERVICES OF ANY KIND. ACCORDINGLY, YOU, FOR YOURSELF
AND FOR EACH OF YOUR FAMILY MEMBERS WHO YOU ENROLL IN THE SECUREDENT PROGRAM THROUGH
THE PLATFORM, AS THE CASE MAY BE, HEREBY FOREVER RELEASE AND DISCHARGE SECUREDENT AND ITS
OFFICERS, DIRECTORS, MEMBERS, AGENTS, EMPLOYEES, AND AFFILIATES FROM ANY AND ALL LIABILITIES,
CLAIMS, DEMANDS, ACTIONS AND CAUSES OF ACTION, WHATSOEVER, THAT YOU OR SUCH FAMILY
MEMBER MAY HAVE BY REASON OF ANY DAMAGE OR PERSONAL INJURY SUSTAINED AS A RESULT OF OR
IN CONNECTION WITH ANY DENTAL SERVICES PROVIDED TO YOU OR YOUR FAMILY MEMBER BY A
DENTIST. YOUR SOLE RECOURSE AGAINST SECUREDENT SHALL BE CANCELLATION OF YOUR ENROLLMENT
IN THE SECUREDENT PROGRAM.
© Secure Dent, Inc. 2022 All Rights Reserved
REV.05.01.2022
INDEMNITY.
You agree to indemnify and hold SecureDent and our directors, officers, agents, contractors, affiliates,
partners and employees, harmless from and against any loss, liability, claim, or demand, including
reasonable attorneys’ fees, arising out of any claim, action, investigation or proceeding made or instituted
by any third party due to or arising out of your participation in the SecureDent Program or your access to
or use of the Platform or the Platform Services.
You hereby agree not to sue, assist in or be a voluntary party to assist in or be a voluntary party to, except
as required by law, any action, suit, or proceeding against us for any claims, actions, suits, damages,
liability, losses or expenses of whatever kind or however arising out your participation in the SecureDent
Program.
LINKS TO OTHER WEBSITES, SOFTWARE, AND SERVICES.
The Platform may contain links to third-party software, services or websites. We are not responsible for
the content, accuracy or opinions expressed on such software, services or websites, and such software,
services or websites are not investigated, monitored or checked for accuracy or completeness by us.
Inclusion of any such software, services or websites on or through the Platform does not imply approval
or endorsement of such software, services or websites by us. If you decide to leave the Platform and
access these such software, services or websites, you do so at your own risk.
GOVERNING LAW; JURISDICTION; STATUTE OF LIMITATIONS.
The Agreement shall be governed by and construed in accordance with the laws of the State of Texas,
without reference to conflicts of those laws’ provisions. Any dispute or claim arising out of, or in
connection with, this Agreement shall be finally settled by courts in Harris County, Texas. In such event,
you consent to the in personam jurisdiction and venue of such courts. You agree that service of process
upon you in any such action may be made if delivered in person, by courier service, or by first class mail,
and shall be deemed effectively given upon receipt. You further agree that, regardless of any statute or
law to the contrary, you must file any such claim or cause of action within one (1) year after such claim or
cause of action arose or be forever barred.
CHANGES TO THESE TERMS AND CONDITIONS.
SecureDent reserves the sole right at any time to modify, discontinue, or delete portions of these Terms.
We will notify you of any material changes to these Terms by email to the email address that you have
registered on the Platform. It is your responsibility to check your email periodically for changes to the
Terms. If you do not agree with the new Terms, you must cancel your membership and stop using the
Platform Services. Your continued use of the Platform, the Platform Services and/or the SecureDent
Program after any changes to these Terms constitutes your acceptance of the revised Terms and
Conditions.
ELECTRONIC COMMUNICATIONS AND SIGNATURES.
When you use the Platform, or send e-mails to us, you are communicating with us electronically. You
consent to receive communications from us electronically. We will communicate with you by e-mail or by
© Secure Dent, Inc. 2022 All Rights Reserved
REV.05.01.2022
posting notices on the Platform. You agree that all agreements, notices, disclosures and other
communications that we provide to you electronically satisfy any legal requirement that such
communications be in writing.
Your use of the Platform includes the ability to enter into agreements and/or to make transactions
electronically. YOU ACKNOWLEDGE THAT YOUR ELECTRONIC SUBMISSIONS CONSTITUTE YOUR
AGREEMENT AND INTENT TO BE BOUND BY AND TO PAY FOR SUCH AGREEMENTS AND TRANSACTIONS.
YOUR AGREEMENT AND INTENT TO BE BOUND BY ELECTRONIC SUBMISSIONS APPLIES TO ALL RECORDS
RELATING TO ALL TRANSACTIONS YOU ENTER INTO ON THE PLATFORM, INCLUDING RENEWALS, POLICIES,
CONTRACTS, AND APPLICATIONS. In order to access and retain your electronic records, you may be
required to have certain hardware and software, which are your sole responsibility.
MISCELLANEOUS.
This Agreement sets forth the entire agreement between you and us pertaining to your participation in
the SecureDent Program and your use of the Platform and the Platform Services. If any provision of this
Agreement is held invalid or unenforceable, such provision shall be revised to the extent necessary to cure
the invalidity or unenforceability, and the remainder of this Agreement shall continue in full force and
effect. Our delay or failure to exercise any right or provision of this Agreementshall not constitute a waiver
of such right or provision. Nothing in this Agreement shall be deemed to confer any third-party rights or
benefits.
This Agreement does not, and shall not be deemed to, constitute a partnership or joint venture between
you and us, and neither you nor SecureDent has the authority to bind the other under any contract,
agreement, or otherwise. We shall not be liable for any failure to perform any of our obligations under
this Agreement if the performance is prevented, hindered or delayed due to any cause beyond the
reasonable control of SecureDent, including, without limitation, unavailability of any communication
system, breach or virus in the processes, sabotage, fire, flood, explosion, acts of nature, civil commotion,
riots, insurrection, war, acts of government, etc.
We reserve the right to transfer, assign or delegate this Agreement. Enrollment and membership in the
SecureDent Program is for your own personal benefit and may not be assigned or delegated by you to
any other person. Any attempted assignment of your membership, Account and/or this Agreement
shall be void. In addition, upon your violation of this provision, in the discretion of SecureDent, and/or
your Dentist, SecureDent may terminate your SecureDent Program membership immediately upon notice
to you.
Should you have any questions regarding your enrollment in or use of the SecureDent Program, please
send an email to info@SecureDent.com.
Any notices provided by SecureDent to you may be given by email to the email address you registered on
the Platform. It is your responsibility to periodically check your email for such notice(s).

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