Appointment Booking Agreement
2186, Route 27, Suite 1B North Brunswick NJ 08902
Street Address Line 2
State / Province
Postal / Zip Code
I agree to pay a non-refundable new patient booking fee of $50.
This amount will be applied towards enrollment in our weight loss service portal for unlimited access to weight loss tools/resources at the time of the first visit.
This amount will be used as a no-show or cancellation fee in the event of no-show or appointment cancellation without 24 hours prior notice.
Should be Empty: