Patient Payment Page

Do you want to make a payment online? You are on the right page. Please enter Patient Number you were given and click the "Make a Payment" button below. Once you click the payment button, you will be taken to a secure payment page. Here you have two payment options to the right of the screen. Select the top option if you wish to pay using a Paypal account. If you would like to simply pay using a debit/credit card select the bottom option. Enter in the amount you would like to pay on the left side of the screen. Thank you for you business and feel free to contact us if you have any questions.

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Accepted Insurances

Medicaid
CHIP
Aetna
BCBS Ferderal Employees Plan
BCBS Preferred
Delta Dental Preferred
Delta Dental Premier
Guardian
Humana
Met Life
Mutual of Omaha
Principal Financial
United Healthcare

Questions

Appointments: *email required

Step 1 How many family members need to be seen?

Please provide full names:

Patient 1 Name:

Patient 2 Name:

Patient 3 Name:

Patient 4 Name:

Patient 5 Name:

Step 2

Do you have insurance?

Yes No

Insurance Company Name:

Reason for the visit?

Yes No

Please explain below:

Step 3

Could we get your contact info?

Name:
email*:
phone:
zip: