Make a Payment

Pay for Appointments and Labs

Use the form below to pay for medical appointments, counseling appointments, dental appointments and labs.

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Full Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Birthdate (mm/dd/yyyy) Note: Select year first.

Payment Type (select one)

Amount (your co-pay or lab pre-pay amount)

Authorize.Net

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