Pay Your Bill

Pay your statement balance mailed to you online using our secure payment form below.

We accept payment from most major credit/debit cards and EFT/ACH transactions from bank accounts.
No additional processing fees

Complete all the required (*) fields and select Submit. A copy of the transaction will be emailed to you using the email address you provide in the Payer Email field.

Patient First Name:*
Patient Last Name:*
Payer Email:*
Payer Phone:*
Patient File #:
Street Address:*
City:*
State:*
Zip:*
Physical Therapy (PT):
Occupational Therapy (OT):
Speech Therapy (ST):
Other Service:
Total:
$0.00
Choose Payment Method:*
- Credit / Debit Card
- Bank Account (EFT/ACH)
Credit / Debit Card:

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Bank Information:
Account Number Account Type Routing Number Account Holder Name
Comments
This field is for validation purposes and should be left unchanged.

Pay Your Bill

Pay your statement balance mailed to you online using our secure payment form below.

Cheshire Location

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