Pay Your Bill

Invoice/Account Number

Patient Name(Required)

First Last

Patient Date of Birth(Required)

Department(Required)

Medical

Dental

Vision

Your Payment Amount(Required)

Make this payment:(Required)

One Time Only

Monthly Payment

Recurring payments are processed on the 1st of the month.

Total

Billing Phone(Required)

Billing Email(Required)

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Kudo Care Center