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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. Riegel (Arvada)
Wesminster Dental Health (Arvada)
New Impressions (Arvada)
Aurora Family Dentistry (Aurora)
Dr. Bowden (Aurora)
Tower Road (Aurora)
Hanu Dental Care (Aurora)
Dr. Joo (Aurora)
Dr. Fahmy (Aurora)
Prospect Ave. (Aurora)
Blue Mesa Dental (Aurora)
28th St. (Boulder)
Bright Now! (Boulder)
Platte River (Brighton)
Dr. Cope (Brighton)
Riverdale Dental (Brighton)
Dr. Marogil (Broomfield)
Dr. Mata (Broomfield)
Dr. Houser (Castle Rock)
Shadow Rock (Castle Rock)
Vogl Dental Arts (Castle Rock)
Dr. Jones (Castle Rock)
Bright Now! (Castle Rock)
Dr. Zirker (Castle Rock)
Dr. Moroni (Castle Rock)
Park Meadows Dental (Centennial)
Dr. Christ (Centennial)
Smoky Hill Family Dental (Centennial)
Dr. Bravo (Centennial)
Dr. Blatter (Centennial)
Dr. Rodriguez (Colorado Springs)
Jade Dental (Colorado Springs)
Cheyenne Mountain (Colorado Springs)
Bright Now! (Colorado Springs)
Blue Mesa Dental (Colorado Springs)
Dr. Brower (Colorado Springs)
Bright Now! (Colorado Springs)
Dr. Camerino (Colorado Springs)
E. 62nd Ave. (Commerce City)
Dr. Yahnian (Denver)
Bright Now! (Denver)
Dr. Elliott (Denver)

Dr. DeWitt (Denver)
Dr. Quandt (Denver)
Bright Now! (Denver)
Dr. Randolph (Denver)
Dr. Sakamaki (Denver)
Newton Street (Denver)
Dr. Wachuta (Denver)
Dr. Madden (Denver)
Dr. Coombs (Denver)
CS Family Dental (Denver)
Accord Dental (Denver)
Dr. Kye Lee (Denver)
Greentree (Denver)
Cherry Hills (Denver)
Ulster St. (Denver)
Dr. Dougherty (Denver)
Dr. Pyne (Denver)
Dr. Ciner (Denver)
Dr. Kuljis (Englewood)
Dr. Case (Englewood)
Dr. Bodoni (Englewood)
Dr. Bevis (Englewood)
Dr. Cowen (Englewood)
Bright Now! (Ft. Collins)
Boardwalk Dental (Ft. Collins)
Dr. Murphy (Ft. Collins)
Dr. Fischer (Ft. Collins)
Clear Creek (Ft. Collins)
Dr. Allen (Ft. Collins)
Dr. Losacco (Georgetown)
Dr. Topelson (Glendale)
Dr. Wachuta (Golden)
Golden View (Golden)
Dr. Clifton (Grand Junction)
Dr. Bingham (Greeley)
Dr. Jamison (Greeley)
Dr. Thorne (Greeley)
Dr. Brown (Greeley)
University Park (Highlands Ranch)
Bright Now! (Highlands Ranch)
Dr. Bender (LaSalle)
Dr. Winnicki (Lafayette)

Dr. White (Lafayette)
Bright Now! (Lakewood)
Dr. Milausnic (Lakewood)
Dr. Chavez (Lakewood)
Dr. Caldwell (Lakewood)
Dr. Paswaters (Lakewood)
Dr. Schroeder (Lakewood)
Dr. Martinez (Lakewood)
Dr. Wise (Lakewood)
Old Town (Littleton)
Guaranteed Smiles (Littleton)
Dr. Lampert (Littleton)
Dr. Preston (Littleton)
Belleview Dental (Littleton)
Dr. Carlile (Littleton)
Dutch Creek (Littleton)
Dr. Kempton (Littleton)
Dr. Ambida (Lone Tree)
Dentistry at Crest (Lone Tree)
Bright Now! (Longmont)
Dr. Brown (Longmont)
Hover St (Longmont)
Dr. Schreiber (Loveland)
Bright Now! (Loveland)
Dr. Ziegler (Northglenn)
Stonegate Dental (Parker)
Soft Touch Dental (Parker)
Dr. Villalon (Pueblo)
Dr. Roberts (Pueblo)
Dr. Saunders (Pueblo)
Gentle Touch (Pueblo)
Dr. Graves (Pueblo)
Eppinger Blvd. (Thornton)
Wesminster Dental Health (Westminster)
Westminster Dental Arts (Westminster)
Bright Now! (Westminster)
Sante Fe (Wheat Ridge)
Dr. Bruhin (Windsor)
Windsor Dental (Windsor)
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New Patient

Employee Information

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First Name Initial

Marital Status

Gender

Birth Date

Home

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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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City

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Zip

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

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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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First Name Initial

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)