Seniors Card holders can receive 10% off their bill up to $500. Patients must mention the discount to reception and reception must sight their Seniors Card.
This offer is only valid for treatment up to $500
There may be outstanding required fields that you need to answer before submitting your form. You should see each field that requires an answer in a red box at the bottom of your form. Once you have answered all fields, if a signature is required, you must sign your signature electronically using your mouse or fingers in the box provided.
If you are still unable to complete the form, you can fill out the form on paper at the clinic before your appointment.