SECURE PAYMENT

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Please enter your account # or the name of your medical practice/facility


Please enter the amount of your payment

Setup recurring payment.

Please enter the amount of your payment.

Number of recurring payments
Automatically charge my card every
Initial Date of
Payment
I understand that the recurring payment will be charged automatically in my credit card according to the plan I set up above.

Pay one time only.

Select the card / payment type:




Send a receipt of this transaction to my email.

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This is a secure 128-bit SSL-encrypted payment facility.
Please review your payment details carefully before clicking the Submit button.