2 Year Terms of Acceptance

I accept the following terms:

By checking off each of the following, you are agreeing to the terms and conditions herein. You MUST agree to all terms for us to approve your Dr. appointment.

My appointment is for a:*

Card Delivery*

Appointment Time*

State Account*

Fees*

Refund Policy*

Digital Signature

By typing your name, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature and consent to be legally bound by this agreement's terms and conditions.