Patient Information

Please follow the steps to make a payment on your account. If you are paying for multiple accounts (ie. you and your spouse or you and your child), you can enter the detailed information from one patient on this screen (below), click "add to cart" to view your entry you can then click "previous" in Step 2 to return to this page and enter additional patient information. This will save you the hassle of entering your payor information more than once.

Your credit card will not be charged until you click "Pay Now" in Step 5. Step 6 is your confirmation notification or you will receive an alert if you were missing any critical payment information.

We hope you find this to be a convenient system and we welcome your feedback via our contact form.

Patient First Name:
Patient Last Name:
Patient Email Address:
Patient Telephone: - -
Your relationship to Patient:
Amount: $
Payment Description: