Plan Member's Full Name *

Email *

Phone *

Plan Details
Enrollment ($450/Year)

Additional members

Plan Acknowledgment
The Dental Health Savings Plan cannot be used: in conjunction with another dental plan, insurance plan, or any other special offers. For services for injuries covered under workman’s compensation. For treatment which, in the sole opinion of the treating dentist or doctor, lies outside the realm of their capability. For referrals to specialists. For hospitalization or hospital charges of any kind. For costs of dental care which is covered under automobile medical coverage. For warranty costs which are separate. Prophylaxis cleanings does not include periodontal treatment. THIS PROGRAM IS NOT DENTAL INSURANCE; IT IS A SAVINGS PLAN EXCLUSIVELY HONORED AT SYRINGA DENTAL AND IMPLANTS.