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Payment Plan Details

Please select one of the following payment plans for the patient. The two financing options are 12 or 24 months. Only select the 24-month option if the patient’s treatment is longer than 18 months. Otherwise select the 12-month option

12 Month Payment Plan
Down Payment: $500.00
Remaining Balance (Paid over 12 Months):
Monthly Payments:
24 Month Payment Plan
Down Payment: $500.00
Remaining Balance (Paid over 24 Months):
Monthly Payments: