In order to make a payment you will need the Visit ID number, which is usually a 6 or 8-digit number that can be found on your statement.

Visa, MasterCard, and Discover are all accepted both online and at our facilities.

We apologize for the inconvenience, as American Express is only accepted at our facilities and not online.

All payments are made via secure server.

Please allow up to two weeks for your payment to post to your account.

Thank you!

Patient Last Name(Required)

Patient First Name(Required)

Patient D.O.B.(Required)

Visit ID Number (Found on Statement)(Required)

Cardholder Email(Required)

Cardholder Phone Number(Required)

Cardholder First Name(Required)

Cardholder Last Name(Required)

Amount of Payment(Required)

(Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)

Total

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Credit Card(Required)

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Captcha(Required)

Comments

This field is for validation purposes and should be left unchanged.

Online Patient Payment Center