Please print these forms out and bring the completed forms to your appointment.
Please Fill Out:
We accept most PPO Insurance Plans. NO HMO / DMO PLANS.
Forms of Payment/Plans
Cash / Check / MasterCard / Visa / American Express / Discover
Automatic Monthly Billing to your MasterCard, Visa, Amex, Discover.
Monthly (no interest) Payment Plans are also available
Uninsured Senior’s Discount
We offer a 10% discount for uninsured senior citizens (65 and older) on cleaning and exams only.