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Enquire About an Invoice
Make a Payment
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Make a Payment
Invoice Number:
*
If you are making a prepayment, your mobile phone number is your invoice number.
Provider name:
*
Enter your provider name located on the top left of your invoice
Email address:
*
Enter Email
Confirm Email
Enter your email address
Patient name:
*
First
Last
Enter your patient name as it appears on the invoice
Invoice Amount
*
Surcharge
Price:
$ 0.00
Invoice Amount Inc Surcharge
$ 0.00
Credit Card
*
Discover
MasterCard
Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
Expiration Date
Security Code
Cardholder Name
Please Note: 1% surcharge applies to all credit card payments
CAPTCHA
Country
Comments
This field is for validation purposes and should be left unchanged.