We welcome all new dental clients!
Please complete the following form to establish your new account. If you have not already set up an appointment, be sure to include the questions about scheduling. Thank you!
All payment is expected at the time of service.
- Credit Card (MC, VISA, AMEX, DISC)
- Paypal (link on home page)
Your prompt payment is valuable to this practice to maintain the highest professional level of services at affordable prices. Any charges not paid at time of service may be assessed a finance charge at an annual rate of 24% plus billing fees. Client agrees that if the account should become past due or delinquent, the client will pay all expenses of collection of the account, including but not limited to collection fees, attorney fees, filing fees, court costs and interest.
Thank you for your cooperation in this matter!