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Notice of Payment Policy

A 3% processing fee is added to credit card transactions—this fee equals our actual cost of acceptance, and is not for profit. This surcharge will appear as a separate item on your receipt. No fees apply to Debit cards or HSA/FSA cards.

Payment Information

Patient Name *

Account Number *

Amount *

Cardholder Name *

Card Number *

Expires (MM/YY) *

CVV *

Billing Address

Street Address *

City *

State *

Zip Code *

Secure Payment Processing

Your payment information is encrypted and secure. We never store your card details.