Stone Dental agrees to provide at a reduced fee for service to the patient certain dental services as described in the Certificate of Care. This Certificate of Care is subject to periodical updates to reflect the current office fee schedules.


This contract may be terminated by the patient with sixty (60) days written notice to Stone Dental. In the event of such termination it is agreed and understood that all prior services rendered will be calculated at the Usual Customary Rate (UCR) with any and all previously received contract payments deducted and the patient will be billed and agrees to pay the balance due. Patient may elect to pay the balance of future contract payments in lieu of replacing the balance of UCR. In any instance, the patient may elect to choose, or otherwise which will be exercised.


Stone Dental has the right to place the patient's contract on HOLD should the patient fail to pay any installment. This means that the patient will not be able to receive discounted services provided for hereunder until all installments are paid up to date. In addition to this, Stone Dental has the right to collect all payments due as stated in TERM 4.


In being further understood and agreed by the parties hereto that the failure of the patient herein to pay any installments on this contract when due, shall at the option of Stone Dental, without demand, or putting in default, cause all unpaid installments to become due at once and collectible. The patient further agrees that in the event of failure to pay any installment on the contract, Stone Dental reserves the right to collect from the patient the balance on services rendered as calculated in TERM 2, or to collect all unpaid installments on contract, whichever is greater, along with all costs incurred to collect money due Stone Dental, as well as attorney fees, collection fees, and all court costs involved in collecting unpaid balance.

Misconduct on the part of the patient shall be grounds for the termination of said contract by Stone Dental. Misconduct shall include, but not limited to, misuse of identification cards, falsifying applications or statements to Stone Dental.


36 Month Contract. All statements and answers in this application are representations made to induce the Issuance of the dental contract offered through the professional corporation as supplied herewith. If this contract application is accepted, the executed contracts will be mailed to the listed address. The applicant hereby aggress to pay to Stone Dental the prevailing subscription fees for said contracts, in advance, on or before the 15th day of each month or by such other date as may be agreed upon. It is understood and agreed that each Participant expressly consents to, authorizes and directs the dentist, consultant, hospital or other person by whom or in which any dental treatment or advice is being, shall have been rendered, to furnish and make available to Stone Dental all such medical and surgical reports, records and other information as Stone Dental may request, at no cost to Stone Dental. It is understood and agreed that each Participant expressly consents to, authorizes and directs Stone Dental at its or its assign's discretion the right to verify credit information as needed for the acceptance of this report.

In consideration of the acceptance of this application, and for other good and valuable consideration, the receipt and sufficiency of which are here by acknowledged, the undersigned, on behalf of itself, its spouse, its children and its family members, its heirs, executors, personal representatives, administrators and assigns and all other persons or entities authorized herein to the contract (hereinafter collectively the "Releasors"), does hereby release and discharge Dr. H. David Hughes, Dental-Kare Affiliated Family Dentistry, A Professional Dental Corporation, i.e, Stone Dental, and all affiliated and assessments, damages, suits, causes of action, or loss whatsoever arising out of, or incident to, either directly or indirectly, the use of Releasors of any of the products or services made available to Releasors my membership in the Dr. H. David Hughes, Dental-Kare Affiliated Family Dentistry, A Professional Dental Corporation, i.e, Stone Dental.