You can use your credit card on our site with confidence. We have partnered with Authorize.Net,
a leading payment gateway since 1996, to offer safe and secure credit card transactions for our customers.
For additional information regarding the privacy of your sensitive cardholder data, please read the Authorize.Net Privacy Policy.

Please complete ALL fields in this form, then click on submit to process your payment.

Patient Account Information

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Credit Card Information

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Credit Card Billing Address

Review the information above, and click "submit" to send your payment.
Electronic confirmation will be sent to the email address provided.

Total: (USD)     

 


 


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