Park Central's Payment Form

Online Payment Form
This form is for your convenience. If you have a balance and need to put something toward it, visit your patient portal and select "View Statement" to download your most current balance. Should you have any questions about your balance, please contact the billing department at (888) 701-8826 opt 5 or ext 8289.
Patient Name *

First Name Last Name
Payment *

USD $10.00 minimum. You will be redirected to PayPal for all electronic payment types.
What I'm paying for *
Best Contact Number *
Patient E-Mail *

Billing Address *

Online Payment Form