Use this form to make payments for:
- Your upcoming surgery
- Scheduling deposit
- Your existing payment plan
Paypal Payment for specific amounts:
You will receive a separate email with link for payment in PayPal.
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.
- The scheduling deposit is $500.00 for surgeries 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 $175.00
- Please click here for instructions on how to send records.