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Dr. Lanny Brustein

First Name *

Last Name *

Phone *

Your E-Mail Address *

Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
3 pack 90 min.	x $397.50	$397.50
MSA - 5 Pack Monthly	x $114.00	$114.00 per month for 5 months ($570.00 total)
Total: $511.50

Cancellation Policy - When our office books your appointment, we are setting aside a dedicated table and time slot just for you. We only ask that if you must reschedule your appointment, please provide us with at least 24 hours notice. This courtesy makes it possible to give your reserved time slot to another patient/client who may be in pain or wanting to get in as soon as possible.

Existing pre-paid packages are charged for that visit for not showing up to scheduled appointments.

*Repeated cancellations or missed appointments will result in loss of future appointment privileges.