Book an Appointment and Request an Invoice for the Anesthesia Deposit  

Please provide an email address where you would like the invoice to be sent to ( Please use your Paypal account associated email, if you do not have PayPal you can still use this form and pay the invoice with a credit card ). An invoice from PayPal will be sent to your email address from Advanced Dental Anesthesia PLLC with 24 hours.

Please note Deposit Payment is due 1 week before the day of the procedure. To ensure this Please sent this invoice request form at ahead of this time to ensure appointment date.

Please review the form below before making the payment. You may fill and send this to your dental office or sign it on the day of the procedure.

Pediatric Patients Financial Agreement and Policy