Hi Wine, This is Janet Pacik and I am the practice manager. All of our vaginismus treatment is done under anesthesia and we use board certified MDs for this. We also have staffing requirements including RNs for the days of surgery. Because of the high costs of staffing on the days we do procedures, it is imperative that the treatment is paid 3 weeks in advance. We simply cannot wait until the day of treatment to find out that the patient cannot pay or the credit card has declined or the personal check has not cleared. We do offer financing from a number of companies such as Care Credit to patients within the US. I hope this helps to understand why we must receive payment in full 3 weeks in advance.