Online Bill Pay

For your convenience, we have set up an online invoice payment service. This service allows you to pay your invoice quickly and securely with your Credit or Debit Card.

* marks are mandatory

Amount*	$
Billing Information
First Name*
Last Name*
Address 1*
Address 2
City*
State*	Select Alberta Alaska Alabama Arkansas Arizona British Columbia California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Manitoba Maryland Maine Michigan Minnesota Missouri Mississippi Montana New Brunswick North Carolina North Dakota Nebraska New Foundland New Hampshire New Jersey New Mexico Nova Scotia Northwest Territories Nunavut Nevada New York Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island South Carolina South Dakota Saskatchewan Tennessee Texas Utah Virginia US Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming Yukon
Zip*
Phone Number*
Email*
Additional Information
Patient Name*
Payment Type*	GTX Payment Patient Payment
Invoice ID*
Payment Information
Credit Card Number*
Name on Card*
Expiry Date*	Month January February March April May June July August September October November December Year 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033
CVV Number*