New Client / Patient Registration Form

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. We also require a non-refundable $60 new patient fee when scheduling the appointment. This goes toward the exam fee at the appointment. The following signature authorizes care and confirms that I have read and understand the payment policy: