MAKE A PAYMENT

PaymentMichael Linck2017-01-23T11:46:50-05:00

Patient Name*
First Last
Patient Account Number*
Your account number may be found on your statement and begins with HF.
Parent or Legal Guardian Email*
Enter Email Confirm Email
Payment Amount for Medical Services*
Total Payment
$0.00
Credit Card*

American Express
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Visa
Card Number Expiration Date Security Code Cardholder Name