Quick Pay

Fast & Secure Patient Payments

To find the Guarantor ID or Visit # look on the sample billing statement provided in your email or appointment confirmation.

Guarantor ID or Visit # * Guarantor ID is required.

Guarantor last name * Guarantor last name is required.

Enter Visit Details

Please provide additional details to complete verification

First Name * First Name is required.

Visit Date * Visit Date is required.

Outstanding Balance * Outstanding Balance is required.

Enter the exact outstanding balance as mentioned in your email

Security Verification Required

For your security, please enter the exact outstanding balance amount as provided in your email. This helps us verify your identity.

Review your bill details before proceeding to payment

Select how you want to pay

Enter Payment Amount

$

All payments are processed through a HIPAA-compliant gateway.

💳

Credit Card

Pay with Visa, Mastercard, Amex, or Discover

🏦

Debit Card

Pay with Visa, Mastercard, Amex, or Discover

Enter your card information

Paying now

$

Card Holder Name * Card Holder Name is required.

Card Number * Card Number is required.

Expiry Month * Expiry Month is required.

Expiry Year * Expiry Year is required.

CVV * CVV is required.

Street Address * Street Address is required.

ZIP Code * ZIP Code is required.

🔐 SSL/TLS Encrypted Connection

💳 PCI DSS Compliant Payment Processing

🛡️ HIPAA Compliance Standards Followed

⚠️ Payment Gateway Timeout

Our secure gateway is experiencing high traffic. Your card has NOT been charged. Please try again after 15 minutes.

Ref ID: #QP-882910