Member Registration Form

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Terms and Conditions:

This will allows you to get 30% discount on Gold Card and 10% on the Basic Cardon all treatment excluding Implants and Orthodontics. The membership Card is only valid for One Year. The treatment taken under should end within the card validity period, otherwise the patient has to pay full amount.
The membership card is only valid for only one member, whose name is on the card. Additional family members can be added to card by paying 250 AED per person.
No additional discount will be given on offers and others. You can only avail discount which is allowed for your card.
The information I declared in this form is valid up to my knowledge. I have read the price list and understood the terms and conditions. Any error in the information provided is my responsibility and Bissan Dental Center will not be responsible of it. I will also be responsible of misusing the card if accountable.
Bissan and its subsidiaries can use this information for contacting and advertising for their service. This information will be used only within company and will not be sold or given to anyone outside of Bissan.
This card is not refundable and not exchangeable.

I have read the terms and condition and I fully agree with these

I have seen the price list and I agree with Prices

Please make sure everything is fine before pressing the send button. Your Card will be sent via Post to your address. Please make sure you have written correct address.