MAKE A PAYMENT Account Holder Full Name * Patient(s) Name * Preferred Contact Number Email Payment Amount Comments Before clicking checkout, please have your PayPal login OR your credit card ready for checkout through the security of PayPal. [contact-form-7 id="1261" title="Contact form 1"] Account Holder Full Name * Patient(s) Name * Preferred Contact Number Email Payment Amount Comments Before clicking checkout, please have your PayPal login OR your credit card ready for checkout through the security of PayPal.
