There are many advantages to use online registration form.
You are completely informed after online registration.
It will save your time on the day of your consultation and/or procedure.
You are able to provide the accurate information in the privacy of your own home or office.
We are able to review your history before you arrive and to call you if there are any medical or social concerns.
This site is secure and your information is kept confidential. This registration form must be completed by the patient only.
To schedule a surgical procedure, a $100 non-refundable and non-transferable fee (payable by Visa or MasterCard credit/debit card only) is required of all patients. (If you do not have a credit card account, pre-paid Visa/MasterCards are available at many stores.) This is credited toward your actual surgery cost. If you cancel or re-schedule for any reason, your $100.00 will not be refunded, and you have to pay new deposit of $100 if you re-schedule your surgical appointment.
Fill in the OnlineRegistration and Deposit Form and click "Submit". Fields marked * are Required Fields.
After registering, we will call you within 2 business days of receiving your registration.