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Access Dental Plan (Individual)

ComprehensiveHealthcareOptions.com, 12835 E. Arapahoe Rd Tower 1 Suite 830 Centennial, CO 80112
Phone: (303) 649-9311 Fax: (303) 649-9036 Toll Free: 1 (866) 870-6399

Membership Information

Plan

Membership

Status

General Dentist

Dental Health of Westminster (Arvada)
Dr. Dylan McKnight (Arvada)
Bright Now! (Arvada)
Dentistry of Colorado-Arvada (Arvada)
Dr. Carrie Dougherty (Aurora)
Comfort Dental (Aurora)
Li'l Teeth Dentistry/Salida Smiles (Aurora)
Alameda Dental (Aurora)
Bright Now! Tower Road (Aurora)
Open and Affordable Dental (Cornell) (Aurora)
Dr. Nelson Joo (Aurora)
Dr. Andy Lee (Aurora)
Dr. Sharon Fahmy (Aurora)
Comfort Dental (Aurora)
Dr. Terrance Wohlbaum (Aurora)
Bright Now! Prospect Ave. (Aurora)
Dr. Christopher Bentley (Aurora)
Cherokee Trail (Aurora)
Dr. Jared Bruggeman (Aurora)
Open and Affordable Dental (Aurora)
Dr. Nichols (Bailey)
Open and Affordable Dental (Bennett)
Dental Health of Boulder (Boulder)
Dr. Daniel (Boulder)
Dentistry of Colorado-Boulder (Boulder)
Riverdale Dental (Brighton)
Open and Affordable Dental (Brighton)
Prairie Center Dental Care (Brighton)
Broomfield Dental Group (Broomfield)
Dr. Marogil (Broomfield)
Dr. Feeley (Broomfield)
Dr. Mata (Broomfield)
Dr. Berry (Broomfield)
Smilelogic (Hygiene only) (Broomfield)
Broadlands Family Dentistry (Broomfield)
Cedar Mountain (Castle Rock)
Bright Now! (Castle Rock)
Vogl Dental Arts (Castle Rock)
Dr. Houser (Castle Rock)
Shadow Rock (Castle Rock)
Glow Comprehensive Dentistry (Castle Rock)
Castle Rock Dental Group (Castle Rock)
High Country Dental (Centennial)
Comfort Dental (Centennial)
Dr. Michael Miller (Centennial)
Heather Park Dental Care (Centennial)
William Case DMD (Centennial)
Orchard Dental (Centennial)
Dr. Sere Myers (Centennial)
Dr. Hudec (Centennial)
University Park Dental (Centennial)
Dr. Rodriguez (Colorado Springs)
Cheyenne Mountain (Colorado Springs)
Sayers Dental (Colorado Springs)
Bright Now! (North Academy) (Colorado Springs)
Jade Dental Professionals (Colorado Springs)
Comfort Dental (Colorado Springs)
Reunion Dental Care (Commerce City)

Commerce City Family Dental (Commerce City)
Comfort Dental (Commerce City)
Dr. Braud (Commerce City)
Dr. Rinaldi (Commerce City)
Comfort Dental (Conifer)
Bright Now! (Denver)
Auraria Dental Oasis (Denver)
Dr. Paini (Denver)
ATA Dental Center (Denver)
Dr. Jacqueline Richmond (Denver)
Capitol Premier Dental Group (Denver)
Open and Affordable Dental (Denver)
Dr. Huskey (Denver)
Dentistry of Colorado-Sloan's Lake (Denver)
Dental Health at Midtown (Denver)
Denver Family Dental (Denver)
Dr. Coombs (Denver)
Dr. Wachuta (Denver)
Accord Dental (Denver)
Dr. Kye Lee (Denver)
Integrity Family Dental (Denver)
Comfort Dental (Denver)
Dental Health at the DTC (Denver)
Dr. Pyne (Denver)
L.M. Kuljis DDS (Englewood)
Dr. Bodoni (Englewood)
DaSilva Family Dentistry (Englewood)
Dr. Shank (Englewood)
Comfort Dental (Englewood)
Vista Ridge Dental Care (Erie)
Open and Affordable (Firestone)
Firestone Dental Care (Firestone)
Dr. Miller (Foxfield)
Dr. Marogil (Frederick)
Dr. Johnson (Ft. Collins)
Bright Now! (Ft. Collins)
Boardwalk Dental (Ft. Collins)
Dr. Allen (Ft. Collins)
Clear Creek (Ft. Collins)
Dr. Losacco (Georgetown)
Dr. Wachuta (Golden)
Golden View (Golden)
Comfort Dental (Grand Junction )
Dr. Brown (Greeley)
Dr. Thorne (Greeley)
Dr. Jamison (Greeley)
William Case DMD (Greenwood Village)
Elena Bodoni DDS (Greenwood Village)
Meyer Dental (Highlands Ranch)
Rock Canyon Dental (Highlands Ranch)
Open and Affordable Dental (Hudson)
Open and Affordable Dental (La Salle)
Dentistry of Colorado-Lafayette (Lafayette)
Dr. White (Lafayette)
Dr. Winnicki (Lafayette)
New Day Dentistry (Lakewood)
Bright Now! (Lakewood)
Dentistry of Colorado-Belmar (Lakewood)

Comfort Dental (Lakewood)
Dr. Milausnic (Lakewood)
Dr. Chavez (Lakewood)
Dr. Caldwell (Lakewood)
Dr. Paswaters (Lakewood)
Comfort Dental (Lakewood)
Dr. Kilroy (Lakewood)
Dr. Schroeder (Lakewood)
Dr. Wise (Lakewood)
Rocky View Dental Care (Littleton)
Guaranteed Smiles (Littleton)
Littleton Family Dental (Littleton)
Old Town (Littleton)
Dr. Kempton (Littleton)
Dr. David Bevans (Littleton)
Dr. David Tomasetti (Littleton)
South Broadway Dental Care (Littleton)
Dr. Lampert (Littleton)
Platte Canyon Dental (Littleton)
Red Rocks Family Dentistry (Littleton)
Dr. Nichols (Littleton)
Clement Park Dental Care (Littleton)
Dr. Oldroyd (Littleton)
Sun Creek Dental Group (Littleton)
Dr. Carlile (Littleton)
Dutch Creek Dental (Littleton)
Lone Tree Pediatric Dentistry (Lone Tree)
Gentle Dental of Lone Tree (Lone Tree)
Dr. Ambida (Lone Tree)
Dental Health of Longmont (Longmont)
Bright Now! (Longmont)
Comfort Dental (Longmont)
Drs. Craig Larson (Longmont)
Open and Affordable Dental (Loveland)
Jackson Creek Dental Care (Monument)
Dr. Ziegler (Northglenn)
Open and Affordable Dental (Parker)
Bright Now! (Parker)
Trail View Dental Care (Parker)
Dr. Thomasson (Parker)
Dr. Roberts (Pueblo)
Dr. Villalon (Pueblo)
Dr. Saunders (Pueblo)
Open and Affordable Dental (Pueblo)
Barron Family Dental (Thornton)
AAA Family Dental Center (Thornton)
Dr. Eric Johnson (Thornton)
Bright Now! (Thornton)
Hilltop Dental Care (Thornton)
Open and Affordable Dental (Wellington)
Wesminster Dental Health (Westminster)
Dr. Dylan McKnight (Westminster)
Bright Now! (Westminster)
Aspen Hill Dental (Wheat Ridge)
Dr. Wachuta (Wheat Ridge)
Dr. Bruhin (Windsor)
Windsor Dental (Windsor)
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New Patient

Member Information

Last Name

First Name Initial

Marital Status

Gender

Birth Date

Home

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City

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Zip

Phone

Work

Employer

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Phone

Num Employees

Dependents

Spouse Information

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First Name Initial

Birth Date

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Work

Employer

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Phone

Num Employees

Insurance

Has Dental

Company

Dental Type

Additional Dependent Information

Relationship

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First Name Initial

Birth Date

Gender

Relationship

Last Name

First Name Initial

Birth Date

Gender

Relationship

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Birth Date

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Relationship

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Birth Date

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Relationship

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Referred By

Comments

Payment of Membership Fees

Upon completion of this form, you will have the option to pay your Membership Fees using your credit card via a secure payment portal. If you choose to pay by credit card, you will receive an email confirmation of payment. If you prefer, you may mail your payment to Comprehensive Healthcare Options, 12835 E. Arapahoe Rd., Tower 1, Suite 830, Centennial CO 80112. Your membership is activated on the day we process your payment.

Terms

I wish to become a member of the Access Dental Plan. I understand the limitations, exclusions and requirements of the plan. I understand that the Access Dental Plan is not insurance. I agree to pay any and all costs in collecting all charges, including but not limited to attorney fees and court costs. I understand membership must be continuous; that membership is on an annual basis; and I may terminate coverage on any anniversary of my enrollment. I understand all fees for services are payable when the services are rendered. I understand that I am eligible for a full refund of membership fees within 30 days of purchasing the Access Dental Plan. I understand that, as a result of cancellation of this plan, my dentist will retroactively bill me for the difference in the amount payable under the plan and his/her services I received while I was a participant of the plan. I understand that participating providers, fees for services and membership fees may change periodically. I certify all information on this form is true.

Acceptance

(Please type "Accept" to accept the terms of this application)