Make A Payment

Payment

Patient First Name*
Patient Last Name*
Patient Date of Birth*
Date Format: MM slash DD slash YYYY
Email Address
Patient Billing Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Account Number*
Should be on your bill or your bill reminder
How much would you like to pay today?*

Once you hit submit you will be taken to PayPal to complete the payment. A PayPal account is not required to pay this way!

You can pay:

-through a credit card without a PayPal account (by clicking “Checkout as guest” at the bottom)

–or with a credit card, debit card, PayPal account balance, checking account, or any other PayPal supported option (like a gift card etc) with a PayPal account