Payment

Billing Information

First Name:
Last Name:
Email Address:
 
Address:
City:
State:
Zip/Postal Code:

Additional Information

Memo/Account Number

Card Information

Card Number:
Expiration: /
Card CVC:
Amount:$

Privacy Policy

We respect and are committed to protecting your privacy. We may collect personally identifiable information when you visit our site. We also automatically receive and record information on our server logs from your browser including your IP address, cookie information and the page(s) you visited. We will not sell your personally identifiable information to anyone.

Return Policy

Payments made for medical services are non-refundable.

Security Policy

Your payment and personal information is always safe. Our Secure Sockets Layer (SSL) software is the industry standard and among the best software available today for secure commerce transactions. It encrypts all of your personal information, including credit card number, name, and address, so that it cannot be read over the internet.