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Great Smiles Wellness Plan Enrollment

Enrollment in Our Great Smiles Wellness Plan is Easy

1. Call our office and schedule your Great Smiles Wellness Plan New Patient Appointment for you and your participating family members. Or, if you have questions, complete the form below and ask our office to call you to schedule your appointment.

2. Complete the online enrollment form below. Or, click here to download a fillable form and email it to

3. Visit our office for your New Patient Appointment. Enrollment fees will be due at the time of service.

    Primary Participant Information

    Plan Participants

    Great Smiles Wellness Plan Terms and Conditions

    This plan is not to be considered insurance and is only offered to those patients without dental insurance.

    The Great Smiles Wellness Plan is renewable on a yearly basis. Fees are non-refundable and non-transferrable. No substitutions allowed. All benefits must be used within the 12-month period after membership is paid in full.

    The cost of the plan is a flat, one-time fee of $442 (Adult), $342 (Child) or $642 (Periodontal) per person per year, due at sign-up. This fee is payable by cash, check, Visa, Master Card or Discover. CareCredit is not applicable.

    This plan is only for The Grove City Center for Dentistry. Specialist referrals are not included in this program.

    Children must be dependents of immediate family members.

    To receive the discount, all balances must be paid in full when services are rendered.

    If a patient cancels an appointment within 2 business days of appointment, he or she will be placed on a 24-hour cancellation restriction. If there is a second cancellation within 24 hours of an appointment, the plan will be nullified and all fees are forfeited.

    Discount does not apply if treatment is due to injury with litigation, disability, or workers compensation.