Pay your bill online
What to have ready before you begin
Before starting the payment process, please have your billing statement on hand. You will need to provide:
- The practice account name listed under “Remit To” on your statement
- The account number shown on your statement
- The amount you wish to pay
- The patient’s first and last name
As the cardholder, you will also be asked to enter your name, address, and contact information. All payments are processed through a secure system, so you can rest assured that your personal information will be kept safe.
Please refer to your statement to complete the form below to securely pay your bill online
PROVIDER INFORMATION
CARD HOLDER INFORMATION
PAYMENT DETAILS
Select Your Address
Multiple matching addresses were found. Please select the correct address to continue.
Confirm Your Payment
Please review the details below. Choose 'Back to Edit' to make corrections, or click on 'Confirm and Pay' to proceed.
Provider information
- Practice State
- Practice Account Name
- Account Name
- Account Number
Patient information
- Patient First Name
- Patient Last Name
Card holder information
- First Name
- Last Name
- Address Line 1
- Address Line 2
- City
- State
- ZIP Code
- Country
Please verify the payment amount and address before continuing.