New Client / Patient Registration Form

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Payment:

We can prepare a written estimate of service fees prior to the examination; if you would like one , just ask a staff member. All fees are due in full at time of service. We accept cash, checks all major credit cards, Apple Pay, google Pay and careCredit. there will be a $35 fee for all returned checks. the following signature authorizes care and the appropriate charges will be assessed in the discharge invoice. Please sign in agreement below:
Click or drag a file to this area to upload.