Pay Online
Payment Details
| Patient Name: | |
| Order Number: | |
| Date of Service: | |
| Payment Amount: |
Please enter your debit or credit card information:
By clicking below, you certify that a) you have reviewed the payment details above
in full; b) you are an authorized user on the credit/debit card account you will use
to pay this balance due; and c) you will not dispute this transaction with your financial
institution now or in the future. A receipt will be provided on screen once the payment has been processed.