Online Payment

Use Paypal for easy and secure online payments:

• Your upcoming surgery
• Scheduling deposit
• Your existing payment plan
• Online consultations

Payment Form

Patient Name *

Email

Appointment Date

(mm/dd/yyyy)

Reason for Payment *

Payment for upcoming visit or procedure

Scheduling / reservation deposit

Payment for my existing payment plan

Online second opinion

Payment Amount in USD *

For the exact amount due, contact us via email or call us at (301) 654-7070

Submit

Important notes:

Payment for upcoming surgery:

• 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.

Scheduling deposit:

• The scheduling deposit is $500.00 for surgeries which will be credited toward services. This will confirm your reservation for the given appointment.
• This is a non-refundable fee

Payment for existing accounts (payment plans):

• Please refer to your agreement for the exact amount of your monthly payment.

Payment for online consultation:

• The fee for online consultation is $195.00
• Please click here for instructions on how to send records to prepare for your online consultation