Enter the amount that you wish to have charged to your debit/credit card. You are able to edit the amount that you wish to charge on a subsequent page.
Follow the online instructions. Fill out your Customer Id. Your Customer Id is also the Patient Account # off of your statement.
If you do not have a statement and you are pre-paying for services, you may enter your Patient Portal ID.
The billing information for your debit/credit card is required. This may or may not be the same as your mailing address. Only your billing address is required.
There is a “Special Notes & Instructions” box if you need to note how the payment needs to be applied. Some examples are “prepayment for surgery”; “prepayment for IVF”; or $160 to my husband’s account and $450 to my account”.
Thank you! Enter Amount
