Payment Agreement

Payment Agreement Terms

Patients are responsible for full payment of services regardless of insurance coverage. If insurance does not cover the estimated amount, the patient agrees to pay any remaining balance. A 3% additional charge may apply if payment is made using any card other than debit/e-transfer. Your credit card will be securely kept on file for any uncovered treatment costs.

Patient Acknowledgment

Type your full name to sign.

8321 Kennedy Rd #22, Markham, ON L3R 5N4 · (905) 470-4289