Pay Bill Online

Any payments over $1,000.00 cannot be processed online.

Payments over $1,000.00 need to be sent to the address that appears on your bill by cashier's check or money order.

* - required fields

Make Payment

Amount:*

Guarantor ID / Account Number:*

Guarantor Name (responsible party): *

Location where services were rendered: *

NOTICE: If Visit ID is not specified, the payment will be applied to the oldest service date with a patient balance owed.

Visit ID:

Payment Date *

Name of patient payment is for *

CC Type:*

Cardholder Name:*

Credit Card #: *

Credit Card Expiration

Month

Year

CVV # (Security Code):*

Billing Address:*

City:*

State:*

Zip:*

Phone:*

Email:*