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Booking Form

Please fill out the following health declaration form in order to book. Submissions are valid up to 24 hours prior to the activity.
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Credit Card Authorization Form

 

Please complete all fields. 

 

Credit Card Information

Card Type:   

       

 

 

 

   

 

 

 

 

 

 

 

 

 

I,                        authorize     to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account.





 

Customer Signature                                           

*By signing this form the you the client agree to a non refundable deposit of goods and services

STEP 2: FILL OUT BOOKING FORM

(Please do not fill areas that do not pertain to your surgery)

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