Please provide the following information:
If "Medical conditions of the same kind or class as or comparable to those listed," Please List Below.
* Note: Your credit card will be charge only after appointment confirmation.
Please note, this is only a preferred appointment time. This does not guarantee the selected appointment time. Our Staff will reach out to confirm the selected time or let you know what else is available.
We strive to deliver the best possible service to our patients. If you wish to cancel up to 48-hours prior to your appointment you will not be charged a fee. We require a minimum of 48-hours cancellation notice for all appointments. There is a 100% ($125.00) fee that will be charged to your card for no-shows / cancellations without a 48-hour notice.