Step 1 - Patient Information
- Begin the online payment process by choosing the clinic where you were treated.
- Patient Name should be the name of the patient's account for whom the payment is applied.
- Account Number is the patient's account number which can be found on the upper left portion of your statement. If you don't have your statement, you can bypass this field.
- Enter the $ amount of your payment. Your credit card and billing information will be collected on the next page.
- Select the Continue to Make Payment button to advance to the next page.
Step 2 - Checkout
- Confirm Your Clinic
- First Name and Last Name are required fields
- Enter a valid email address so that we can email you a confirmation that your payment request was received
- Enter the billing address for your credit card
- Enter the City, State, and Zip Code which also matches the billing address for your credit card
- If the billing address you enter doesn't match the address on file with your credit card, your payment will not go through
- Enter a current phone # so that we can reach you if there are any problems with your payment
- Select your Credit Card type from the list of accepted credit cards.
- Enter the credit card number exactly as printed on your card.
- Select your credit card's expiration month and calendar year
- Enter the 3 digit code which is usually found on the back of your credit card.
- Verify your payment amount
- Select the Submit Payment button to finalize your payment.