Smile Plan Enrollment Request

This form is a request to enroll in the Progressive Dental Smile Plan.
To complete enrollment, you’ll need to schedule an appointment and finalize your Smile Plan in-office. The full annual fee is due at the time of enrollment.

If you have questions, submit this form and a member of our team will reach out to assist you. You’re also welcome to schedule an appointment online or by phone and discuss the Smile Plan during your visit.