Please fill out the 2 forms below:

Please note that we are a “fee for service” medical entity and we do not accept any insurances.

Please be aware that the deposit is due 10 business days (2 Weeks) before the day of the procedure.

The deposit guarantees your date of procedure and without it, your agreed-upon date will be postponed. No exceptions. BOTH FORM Should be filled at the same setting

Adult Forms:

Medical Questionnaire

Financial Disclosure & Form

Pediatric forms (Less than 18 years old):

Pediatric Medical Questionnaire

Financial agreement & disclosure