Secured by PayPal

Below is a simple way to pay some or all of your bill. You may also use this form to store a card on file for future use.

  • Payment made here will either be applied to the invoice entered below or to the oldest outstanding balance on the patient’s file.
  • We use PayPal to process these payments, and you will receive an email confirmation of your payment.
  • If you select your therapist’s email below, they will also receive an emailed confirmation of your payment.
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(This is optional. If the invoice entered here matches with an outstanding invoice on file, the payment will be applied to that invoice. If nothing is entered here, the payment will be applied to the oldest outstanding balance on the patient's file)
For emailed receipt of payment
If you want your therapist to receive an instantaneous notification of your payment, select their email address above, otherwise don't make a selection.
Individual filling out this form