Pay For Treatment

We Accept Visa and Mastercard

Full Name:
Address:
City:
Province/State:
Postal/Zip Code:
Phone:
Payment For:
Name of Client:
Amount: $ *
* when entering the amount, use only numbers and a decimal point, followed by the cents. For example if you are entering $500 PLEASE ENTER 500.00

** You will be directed to a secure server

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