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Online Patient Payment Center
Our online bill pay feature is currently unavailable. Please contact the business office during working hours for payment assistance. (620) 583-7451
*	Name Of Patient Name of Patient Treated.
*	Patient Account Number Account Number. (Should Be Located On Your Bill)
*	Your E-Mail Address Please Provide An E-mail Address.
*	Billing Name Name on Credit Card.
	Comments Or Messages Related To Your Payment
*	Amount of Payment Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)	$
*	Card Number
*	Expiration Date	12345678910111220242025202620272028202920302031203220332034
*	Card Code Verification Number The three digit number on the back of your card. (Four digit code on the front of American Express.)
*	Email Address
*	Billing Postal or Street Address
*	Billing City
*	Billing State	AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
*	Billing Zip Code 5 digit zip code