As Low as $325 /yr. Our Affordable Plan Includes the Following Services at No Charge: Please List All Unmarried Children Up to Age 26 1. Child’s First Name _________________________ Middle Initial ______________ Son / Daughter Date of Birth ______________________________ 2. Child’s First Name _________________________ Middle Initial ______________ Son / Daughter Date of Birth ______________________________ 3. Child’s First Name _________________________ Middle Initial ______________ Son / Daughter Date of Birth ______________________________ 4. Child’s First Name _________________________ Middle Initial ______________ Son / Daughter Date of Birth ______________________________ 5. Child’s First Name _________________________ Middle Initial ______________ Son / Daughter Date of Birth ______________________________ • Comprehensive Exam (once every six months) • Fluoride Treatment for Children (under the age of 16, once every six months) • X-Rays (once every 12 months) • Cleaning (Prophylaxis) (once every six months, twice per calendar year) • Velscope (oral cancer screening) Affordable Dental Coverage For You & Your Entire Family We’re Making Excellence in Dentistry Affordable for You! /yr. Low-Cost Individual Dental Plan As Low as $325 Join Costello Dental Excellence’s In-House Premier Dental Plan Enroll Today! • • • • • • All Health Conditions Accepted! You Cannot Be Denied Coverage! No Deductibles! You Cannot Be Singled Out for Rate Increases or Cancellations! Convenient Appointments Before & After Work & on Saturdays No Maximums & No Waiting Periods! 1510 N Arlington Heights Rd Arlington Heights, IL 60004 We cordially invite you to call (847) 259-1111 www.CostelloDental.com Our office is conveniently located two blocks south of Palatine Road on the west side of the street. at Costello Dental Excellence. You save on everything It’s a discounted fee schedule for most services, only good from cleanings & fillings to cosmetic procedures & crowns! Please Fill Out & Send This Form in Today to Begin Coverage! C M Y CM MY CY CMY K Costello Dental Brochure Exterior Spread Redesigned.ai 1 8/27/14 12:54 PM Costello Dental Brochure Exterior Spread Redesigned.ai 1 8/27/14 12:54 PM