Apr 1, 2016
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*DISCLAIMER: THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT OR ANY OTHER SERVICE, EXAMINATION OR TREATMENT WHICH IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OR RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION OR TREATMENT.
MEDICARE AND MEDICAID ARE NOT ELIGIBLE FOR THIS OFFER AND DOES NOT APPLY TO FEDERAL OR ACN BENEFICIARIES ($150 VALUE)
Preferred Time of Day for Appointment (required)