Peak Pay

Simplify your payments with Peak Pay! No more stress with copays or balances due. Sign up for our hassle-free and secure auto-pay system and save time, no more annoying billing fees, and goodbye to awkward phone conversations reading your credit card number at check-in. Make your life easier with Peak Pay today!

And Peak Pay is good for the environment too. We're all about reducing paper usage; with digital payments, you're helping us achieve this goal.

Peak Pay Terms

I agree to the following terms and conditions of Peak Pay:

Securely store my credit/debit card for use in Peak Pay for all children on my account
Authorize the use of Peak Pay for auto-charging co-pays and balances under $200
Charges over $200 will only occur with my approval
Auto-charging for balances will only occur after the insurance EOB received
Receipts for all Peak Pay transactions will be emailed to the address on file

Have you read and agree to the Peak Pay terms listed above?*

Yes, I agreeNo

We're sorry, but you must agree to the terms to enroll in Peak Pay and leave a credit card on file with our office.

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Name of Parent or Guardian*

Signature*

Clear

Date*

Date