SCHEDULING REQUIRES COMPLETED FORMS AND A PAID DEPOSIT

All forms are securely encrypted and HIPAA compliant

Pre-Anesthesia Intake and Health History Form

Consent Form

Insurance and Payment Acknowledgement

Financial Responsibility and Additional Charges

The anesthesia deposit paid prior to the appointment will be applied toward the final anesthesia charges. Total fees are determined by services rendered, and any remaining balance must be paid in full on the day of service.

Secure Payment

Complete Your Payment

You are about to pay securely via Square. Click the button below to proceed to the checkout page.

Pay Now
Secured by Square