■ Discounted package is valid for local residents only (living or working in Miami-Dade county).
■ One discounted package per person. Not available for individuals on federal programs such as Medicare or Medicaid.
(Note: rest assured we are required by law to keep all information, including this form confidential)
The patient and any other person responsible for payment has the right to refuse to pay, cancel payment or be reimbursed for payment for any other service, examination or treatment which is performed as a result of and within 72 hours of bonding to the advertisement for the free, discounted or reduced fee services, examination or treatment.