Bill Pay
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Fields are required information.
Patient Name
First Name
Last Name
Service you are Paying for
Past Bill
Virtual Visit/Copay
Other Fee to include No Show fee
Document Fee
Invoice # if available
Enter Payment amount.
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USD
Credit Card
E-mail
A receipt will be sent to this address.
Phone Number
In case we need to contact you.
Message if you would like to leave one.
Submit Payment
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