Private Pay

PRIVATE PAY

Submit a payment, & request an appointment. We will be in touch shortly to confirm your appointment date & time.

Step 1. Enter your information by filling out the Private Pay form below. Once you hit submit you will be brought to a secure page where you can enter your credit card information. Upon completion come back here and proceed to step 2.

Step 2. Use our online booking system to request an appointment

Once everything is verified you will be scheduled and notified.

PRIVATE PAY INFORMATION

Pay in full ($75)

$

Your Name

Email Address

Date of Birth

Phone

Address

City

State

Zip

Reason for your visit