Return to Shop
View Your Cart

Make a Payment

From the drop-down list, please select one of two options: “Deposit for future services” or “Payment toward account balance.” This is a required field.

From the drop-down list, please select where you receive your service.

Please provide the name of the patient whose account will be credited with this payment. This may be different than the name of the person making the payment. This is a required field.

RELATED PRODUCTS

Other Items You Might Like