Credit Card Authorization

  • I Certify, that I am a signer on the account listed below with the authority to grant this authorization to be billed for any amount my insurance provider does not cover.

    Rescheduling & Cancellation Policy
    We require that you must call within 48 business hours prior to your scheduled study to cancel or re-schedule. Failure to do so will result in a $100.00 cancellation fee.