Make a payment

Make a payment
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Payment Amount

CAD$50.00 deposit for new sedation patient consultation is fully-refundable, except in case of short-notice cancellation. For other payments, enter the exact amount.

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

You'll receive a confirmation receipt by email and we'll be notified of your payment. All payments are processed securely by Moneris (the same as in our office).
Verification
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Payment Amount*

Payment Amount