Test form Signups
| Status | Future |
|---|---|
| Misc Member Notes | Called for prices on procedure codes. Said her dental office told her that they are going to be opting out of DenteMax & will have their own discount plan 8/29/19 KS Planning to send a check in for renewal 3/2/20 EK GFGF, 1 month added for referring Renee Ochmanek, creating GFGF packet. 4/6/2021 MT Member called to say that her longtime dentist Talcott is no longer accepting, I confirmed on our site. I gave her a few names of other dentists with zip 48375 and she is going to reach out to them. I explained that we utilize DM and how procedure codes work. She was wanting a list of fees. 4/22/2021 MT Member called in to say that we could give her a list of fees, so she was told. I let her know we can look those up over the phone. Gave her ranges for crowns at DLN Chouiery (fee sched 97) and DLN Salah/Sheena (fee sched 103) and prices for D0140, 2740, 0220, 1206, 2393. I explained DM and how our list is updated. 5/10/2021 MT Called member back, she wondered why she hasn’t gotten notice to renew, told her her plan doesn’t expire until Oct. I told her she would be getting an exp let soon, one should be sent out next week. 08/15/25 MT Member called to get fees, told her can only quote 2025 at the moment, DM site down. She is going to reach out to her office. 05/05/26 MT Member called to say she's mailing a check. 09/22/26 MT ExMail 1-5-18, ExMail 1/22/19, ExMail 3/9/2020, ExMail 3/25/21, ExMail 05/24/22, ExMail 07/03/23, ExMail 07/15/24, ExMail 09/11/25, Member called to see when she's getting mcards, told her on the way. 10/09/26 MT |
| Membership Type | Family Plan ($139.95) |
| Are you renewing your plan? | Yes |
| Please enter your current membership ID# here. You can find this in your renewal email or on your current membership card. | 1757602443 |
| Your Name | Beverly Feliks |
| Email hidden; Javascript is required. | |
| Phone | (248) 348-1967 |
| Date of Birth | 11/17/1941 |
| List Family Members | Daniel |
| Referred by or Referral Code | ExMail 9/29/26 |
| Enter Office Code | A22274 |
| Address | 21911 Bedford Dr Northville, MI 48167 Map It |
| Payment Method | Check |
| Payment Received | Paid |
| Total | $139.95 |
| Go Green | Paperless Option | not |
| Terms |  I have read the Terms and Conditions and wish to purchase the Discount Medical Plan. |
| Plan Information | |
| Newest Membership: Programmatically pick Plan Start Date Based on either new plan or their ID number here | 11/14/2026 |
| Newest Membership: Programmatically pick Expiration Date Based on either new plan or their ID number here | 12/14/2027 |
| Membership ID Number | 1790698375 |
| Past Plan Information | this probably isn't needed there should already be additional entries |
| Resend Sign Up Email | 8 |
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