Your browser does not support JavaScript!
This form cannot automatically check that you have submitted all of the required fields without JavaScript.
Please be sure to submit all required fields (marked with stars).

Andrews Sports Medicine & Orthopaedic Center

Online Patient Payment Center

Welcome to Andrews Sports Medicine & Orthopaedic Center Online Payment Center. You may pay your physician bills here by credit card.
For your convenience please fill out the payment form below. All information will be kept secure and confidential. For more information you may call our business office during working hours.

You may make payments to Andrews Sports Medicine & Orthopaedic Center using your credit card information in the fields below. All payments are via secure server. Thank you for allowing us to serve you.
* Name Of Patient
Name of Patient Treated.
* Account Number
Account Number. (Should Be Located On Your Bill)
* Name of Payor
Payor's Name on Credit Card.
* Your E-Mail Address
Please Provide An E-mail Address.
  Comments Or Messages Related To Your Payment
Billing Information
* Amount of Payment
Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)
$
* Card Number
* Expiration Date
* Card Code Verification Number
The three digit number on the back of your card. (Four digit code on the front of American Express.)
* Billing Postal or Street Address
* Billing City
* Billing State
* Billing Zip Code
5 digit zip code