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Patient Payment Portal
Payment Portal
Please complete the following information and hit submit. You will then be taken to a PayPal screen where you can safely and securely input your card information for payment. To pay with a credit or debit card select to the grey button labeled "Pay with Credit or Debit Card".
Patient Information
Patient Name
*
First
Last
Amount Due
*
Enter the amount on your paper invoice under "AMOUNT DUE"
Patient Number
*
Located on your invoice beside your name
Billing Address
*
Street Address
Address Line 2
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*
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