Welcome to our SECURE page to submit your direct payments!

Report all direct pays via this form. All fields are required to be completed except for the Patient’s Name and Comments box before you hit submit. Use the Comments box for any special notes you’d like to send in with the direct pay. An option to send a confirmation email, indicating we did receive your direct pay entry, is available.

If you have any questions, feel free to give us a call and we’ll be glad to assist you.

Have a great day and thank you for your business!