Pay Your Medical Bill
You may pay your medical bill here and you will receive a receipt to your email. Please allow 90 days for your account to update and ignore any further statements until after 90 Days. Thank you for choosing Michigan Avenue Podiatry Clinic | Olympia Foot & Ankle LTD. Should you have any questions regarding your bill or this form please email us at admin@michiganavenuepodiatry.com or call us at 312-701-0770
Patients Full Name
*
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Message
What are you paying for?
Co-Pay
Bill In the Mail
Orthotics or Other
FMLA, Employer Paper Work or Other Documents (please note this is a $75 charge and you must upload all documents to be filled out as well as any special instructions). You will receive your paperwork in your email within 24-72 hours.
FMLA or Other Paperwork
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of
Upload Image of Bill
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Total Payment
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USD
Description
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
ACH Bank Transfer
Afterpay
After submitting the form, you will be redirected to Afterpay to complete the payment.
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