New Patient Form

Payment is due at the time of service rendered. Payment can be made in the form of cash, check, debit card, or credit card. At your request, we are happy to provide an estimate for services. If we proceed to collectors for any account past due the client is responsible for all costs including attorney fees. A $10 late charge will be added to all accounts in default at the end of each month. The client will be responsible for all fees incurred or any returned checks.