You’ll use this page if you are planning a procedure with us and would like to use Nitrous Oxide, or have had a recent procedure with us and need to pay for your use of Nitrous Oxide. When you submit your information below, a charge will be reserved on your credit card for $100. The charge will be captured after the procedure.  

Nitrous Payment
Credit Card *

Consent for use of Nitrous Oxide

Agreement *