Online Payment Form

Please use the following form to make a payment towards your account balance. Enter the Patient's Full Name and Patient ID as listed on the invoice we sent to you. You will be directed to a PayPal Secure Checkout page after pressing the Pay Now button. You may then choose to log in to an existing PayPal account. Alternatively, if you do not have a PayPal account or do not wish to create one, click the "Pay with debit or credit card" link below the login form.

If you have any questions please do not hesitate to call us.