Make a Payment on My Account

Make a Payment on My Account

Here, you can make a payment on your account. Our system uses Paypal, a secure payment system.
Which clinician(s) are you seeing?
You can select multiple clinicians if needed.
What is the name of the Client?
Click here if needed:
What is the name of the additional Client?
Your name:
A phone number where we can reach you if needed:
Please enter a valid phone number.Format: (000) 000-0000.
Your email address (optional)
If you give us your email address, you give us permission to contact you about this payment via email, if needed, and to send you a receipt.
Any additional information you wish to include:
If paying for more than one client, be sure to tell us how much you want to pay for each one.
Enter an amount to pay on your account.

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You may choose to receive a confirmation of your submission. It will ONLY include the method of payment and the amount, but will not include any other information. The confirmation will be sent over regular email (not encrypted).
You have chosen to receive confirmation. Please re-enter your email address:

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If you don't want to use your Paypal account, or don't have one, choose Debit or Credit Card, below.

Debit or Credit Card

Choose from one of the PayPal options to make your payment.