Set Up Credit Card Installment Payments

Installment Payment Information

Please Contact office first before establishing payment plan

You may authorize use of your credit card to make recurring monthly payments on a large past due balance. To use this option, you must first have the arrangement approved by our office staff. Please contact the billing manager at 610-626-8085 ext. 201 to make arrangements.

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Please Complete ALL fields STARTING WITH Patient's Name

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Patient Information

Credit Card Information

Payment Information


The default is 6 installments. But you can change it to any number from 2 to a 100
 
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