Online Payment - Dr Omar Breik
Secure payment by Credit or Debit Card. Please note that a surcharge of 1% applies to payments made online via credit or debit card. Please see your invoice for alternate payment options.
Calculation
Name of Patient
*
Name of patient undergoing surgery
Email
Confirmation of your deposit payment will be sent to your nominated email address.
Invoice Amount
*
Please see your invoice for your surgery fee. This amount will be held in deposit. When your surgery is complete a tax receipt will be issued.
Total Payment
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( X )
AUD
A 1% surcharge is applied to online payments.
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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Should be Empty: