The following make up the terms and conditions of your registration under our dental payment plan at Mola Dental.
It is recommended that you read them carefully and keep them in a safe place so that you can refer to them in the
future, should you need to. Please remember, the agreement is with Mola Dental and cannot be transferred to or
used at any other Dental Practice other than Mola Dental. The direct debit you have in place to cover the cost of
your payment plan constitutes your agreement to the terms outlined herein.

Initial Term
The initial minimum term of your dental plan is 12 months. If you terminate your dental plan before this period,
the practice reserves the right to recoup any outstanding fees for services and discounts already provided.

Monthly Fee and Direct Debit collection:
Your monthly plan fee will be collected by direct debit on the 1
st of each month or shortly after.

Plan fee amendments:
Your plan fee is subject to change at any time. The practice will endeavour to review plan fees once per annum
and should your plan fee change, you will be given advance notice by either post or email.

Plan Cancellation:
You may cancel your plan at any time by informing the practice outside of the initial term. The practice reserves
the right to recoup any outstanding fees as mentioned above.

Non-payment:
If we are unable to collect your regular plan fee for any reason, we will contact you to collect any outstanding fees
which can be collected by direct debit or paid to the practice directly by cash or card.
Failure to attend appointments:
You are responsible for attending appointments made with your dentist and/or hygienist and you may need to pay
a ‘missed appointment’ fee or forfeit the failed plan inclusive appointment should you fail to do so.

Responsibilities
You must ensure that you attend your dentist for regular examinations, and you must promptly inform your dentist
of any injury, problem or other material matter affecting your oral health. We will endeavour to contact you and
remind you of your dental plan inclusive Exams and Hygiene appointments either by email or text – however you
are solely responsible for ensuring that all your inclusive Dental Exams and Hygiene appointments are booked
and used within the 12-month period (from date of first inclusive Exam or Hygiene appointment) If your contact
details change you must inform us as soon as possible so that we can ensure you get your appointment
reminders

Refunds
As mentioned above, it is your sole responsibility to book your inclusive plan appointments. Refunds cannot be
granted for any unused entitlement.

Complaints:
Please refer to the practice’s complaint procedure should you be unhappy with the care you receive.

I have read and understand and accept the terms of the agreement for a minimum of 12 months.