1305 N. Willow Ave., Suite 110, Clovis, CA 93619 - Phone: 
            559-323-2111
    
    
        
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            Print this form and fax or bring it with you to your appointment.
        
            Financial Information
        
            We are dedicated to helping you maintain a healthy smile for a lifetime.  We
            will discuss all your dental options and cost with you prior to treatment. You can
            pay for your treatment by cash, check, credit or debit card at the time of treatment. 
            We also accept most major dental insurances, and CareCredit.
        
            For more information about financing, please visit:
        
            CareCredit
        
            To discuss your payment options or insurance coverage, please call (559) 323-2111.