Make Payment

Easy and Convenient Online Payments

Making your payment is simple! Just follow the steps below to pay for your upcoming appointment or settle any outstanding balance on your account.

Fill in the form with your First Name, Last Name, Email Address, and Phone Number.
Enter the Total Amount Due from your invoice in the payment field.
After entering the amount, the secure payment gateway will prompt you to input your Credit Card Information (Card Number, Expiration Date, and CVV).
Under Customer Reference ID, please provide the Patient’s Full Name or Patient ID to ensure your payment is correctly applied.
Complete the transaction, and you’ll receive a receipt via email for your records.

IMPORTANT: Ensure that you accurately enter the Patient’s Full Name or Patient ID under the Customer Reference ID field.

Custom Payment Form

First Name

Last Name

Phone/Mobile

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Payment Amount

Customer Reference ID

Pay with Card (Stripe)

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