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Access Dental Plan (Individual)

ComprehensiveHealthcareOptions.com, 12835 E. Arapahoe Rd Tower 1 Suite 330 Centennial, CO 80112
Phone: (303) 649-9311 Fax: (303) 649-9036 Toll Free: 1 (866) 870-6399

Membership Information

Plan

Membership

Status

General Dentist

Dr. Mata (Arvada)
Dr. Riegel (Arvada)
Wesminster Dental Health (Arvada)
Bright Now! (Arvada)
Comfort Dental (Aurora)
Dr. Kinder (Aurora)
Dr. Bowden (Aurora)
Windsor Dental Care (Aurora)
Tower Road (Aurora)
Hanu Dental Care (Aurora)
Dr. Joo (Aurora)
Dr. Andy Lee (Aurora)
Dr. Fahmy (Aurora)
Comfort Dental (Aurora)
Prospect Ave. (Aurora)
Dr. Gryzick (Aurora)
Dr. Bentley (Aurora)
28th St. (Boulder)
Dr. Daniel (Boulder)
Bright Now! (Boulder)
Prairie Center Dental Care (Brighton)
Riverdale Dental (Brighton)
Mountain View Family Dental (Brighton)
Platte River (Brighton)
Broomfield Dental Group (Broomfield)
Dr. Marogil (Broomfield)
Dr. Mata (Broomfield)
Amherst Park Family Dental (Broomfield)
Bright Now! (Castle Rock)
Vogl Dental Arts (Castle Rock)
Dr. Houser (Castle Rock)
Shadow Rock (Castle Rock)
Cedar Mountain (Castle Rock)
Dr. Moroni (Castle Rock)
Dr. Jones (Castle Rock)
Smoky Hill Family Dental (Centennial)
High Country Dental (Centennial)
Heather Park Dental Care (Centennial)
Comfort Dental (Centennial)
Dr. Michael Miller (Centennial)
Orchard Dental (Centennial)
Dr. Myers (Centennial)
Park Meadows Dental (Centennial)
Dr. Christ (Centennial)
Dr. Bravo (Centennial)
Sarah Meyer, DDS (Centennial)
University Park Dental (Centennial)
Dr. Brower (Colorado Springs)
Dr. Rodriguez (Colorado Springs)
Cheyenne Mountain (Colorado Springs)
Bright Now! (Colorado Springs)
Bright Smiles Dental (Colorado Springs)
Bright Now! (Colorado Springs)
Jade Dental Professionals (Colorado Springs)
Dr. Camerino (Colorado Springs)
North Summit Dental Care (Colorado Springs)

Reunion Dental Care (Commerce City)
E. 62nd Ave. (Commerce City)
Comfort Dental (Commerce City)
Comfort Dental (Conifer)
Dr. Yahnian (Denver)
Bright Now! (Denver)
ATA Dental Center (Denver)
Dr. Paini (Denver)
Auraria Dental Oasis (Denver)
Dr. Moore (Denver)
Dr. Quandt (Denver)
Dr. Collis Johnson (Denver)
Bright Now! (Denver)
Dr. Randolph (Denver)
Dr. Huskey (Denver)
Dr. Sakamaki (Denver)
Newton Street (Denver)
Denver Family Dental (Denver)
Dr. Coombs (Denver)
Dr. Wachuta (Denver)
Dr. Madden (Denver)
Accord Dental (Denver)
CS Family Dental (Denver)
Dr. Kye Lee (Denver)
Greentree (Denver)
Comfort Dental (Denver)
Hampden Family Dental (Denver)
Cherry Hills (Denver)
Ulster St. (Denver)
Dr. Dougherty (Denver)
Dr. Pyne (Denver)
Ian Topelson, DMD (Denver)
Dr. Kuljis (Englewood)
Dr. Case (Englewood)
Dr. Shank (Englewood)
Comfort Dental (Englewood)
Dr. Cowen (Englewood)
Vista Ridge Dental Care (Erie)
Firestone Dental Care (Firestone)
Dr. Miller (Foxfield)
Bright Now! (Ft. Collins)
Dr. Johnson (Ft. Collins)
Dr. Fischer (Ft. Collins)
Boardwalk Dental (Ft. Collins)
Dr. Murphy (Ft. Collins)
Dr. Allen (Ft. Collins)
Clear Creek (Ft. Collins)
Dr. Losacco (Georgetown)
Dr. Topelson (Glendale)
Dr. Wachuta (Golden)
Golden View (Golden)
Grand Dental (Grand Junction)
Dr. Brown (Greeley)
Dr. Thorne (Greeley)
Dr. Jamison (Greeley)
Elena Bodoni DDS (Greenwood Village)

Rock Canyon Dental Care (Highlands Ranch)
Bright Now! (Highlands Ranch)
Dr. Bender (LaSalle)
Dr. White (Lafayette)
Dr. Winnicki (Lafayette)
Bright Now! (Lakewood)
Comfort Dental (Lakewood)
Dr. Milausnic (Lakewood)
Dr. Chavez (Lakewood)
Dr. Paswaters (Lakewood)
Dr. Martinez (Lakewood)
Dr. Schroeder (Lakewood)
Dr. Wise (Lakewood)
Old Town (Littleton)
Rocky View Dental Care (Littleton)
Dr. Moreland (Littleton)
Guaranteed Smiles (Littleton)
Dr. Kempton (Littleton)
Dr. Lampert (Littleton)
Clement Park Dental Care (Littleton)
Dr. Preston (Littleton)
Swedish Healthpark Dental Arts (Littleton)
Littleton Dental (Littleton)
Belleview Dental (Littleton)
Dr. Carlile (Littleton)
Dutch Creek (Littleton)
Classic Dental (Lone Tree)
Dr. Ambida (Lone Tree)
Dr. Ronald Lambert (Longmont)
Hover St (Longmont)
Dr. Hanks (Longmont)
Bright Now! (Longmont)
Dr. Brown (Longmont)
Dr. Richard Shulze (Loveland)
Bright Now! (Loveland)
Jackson Creek Dental Care (Monument)
Comfort Dental (Monument)
Dr. Ziegler (Northglenn)
Alpha Dental North (Northglenn)
Trail View Dental Care (Parker)
Dr. Roberts (Pueblo)
Dr. Villalon (Pueblo)
Dr. Saunders (Pueblo)
Dr. Graves (Pueblo)
Gentle Touch (Pueblo)
Bright Now! (Thornton)
Eppinger Blvd. (Thornton)
Hilltop Dental Care (Thornton)
Wesminster Dental Health (Westminster)
Westminster Dental Arts (Westminster)
Bright Now! (Westminster)
Aspen Hill Dental (Wheat Ridge)
Dr. Bruhin (Windsor)
Windsor Dental (Windsor)
()

New Patient

Employee Information

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First Name Initial

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Gender

Birth Date

Home

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Work

Employer

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Dependents

Spouse Information

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First Name Initial

Birth Date

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Work

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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

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Relationship

Last Name

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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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Birth Date

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Relationship

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Birth Date

Gender

Referred By

Comments

Payment of Membership Fees

Please call (303) 649-9311 or (866) 870-6399 to pay your Membership fees. You may also mail your payment to Comprehensive Healthcare Options, 12835 E. Arapahoe Rd., Tower 1, Suite 330, 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)