Patient Account Payments

Patient Portal Log In

For your convenience please find below our online Payment Button link.  These payments are accepted through our Square account.    

Please complete the Credit Card Authorization Form and send either by Email button to our office or Fax.  Your form will be uploaded to your Chart for HIPAA compliant storage and email will be deleted from our system.  

You will be redirected to our Square payment processing portal to apply your payment(s) to your account.

Please complete our Credit Card Authorization form and SUBMIT back to Us by Email or Fax to (813) 960-9020

Thank You We Appreciate Your Payment!

To download a  FREE updated Version of Adobe Reader click above, in order to view our forms.