Use this form to make payments for:
- Your upcoming surgery
- Scheduling deposit
- Your existing payment plan
Once you submit this form, you will be redirected to Paypal to complete your payment. Please be patient as the process can take several seconds.
Important Notes
Payment for upcoming surgery:
- You may make online payment for your upcoming surgery or visit. Please speak to our treatment coordinator about the exact fees.
- Your payment will be credited to your account. On the day of surgery, your payment will be posted towards services provided.
- Your payment is fully refundable if surgery is canceled for any reason. If you have an existing balance from prior visits, it will be deducted from your payment.
Scheduling deposit:
- The scheduling deposit is $50.00 which will be credited toward services. This will confirm your reservation for the given appointment.
- There will be a $25 charge for any cancellations made on the day of appointment.
- There will be a $50 charge if you fail to keep your appointment with no prior notification.
Payment for existing accounts (payment plans):
- Please refer to your agreement for the exact amount of your monthly payment.
Payment for second opinion:
- The fee for obtaining online second opinions is $150.00
- Please click here for instructions on how to send records.