Pay With A Credit Card
(including HSA and FSA cards)
Payment Instructions
Please enter ALL information requested below:
1. Enter payment amount and click “Make A Payment” below.
2. Please enter email address to receive receipt of payment.
IN The NOTES Box (on following page)…
3. Please enter Therapist’s LAST NAME.
4. If paying on behalf of a minor OR person (other than yourself) please enter
their First initial and Last Name, along with Therapist’s Last Name.
Thank you!