PayPal Bill Pay

Use the form below to submit your payment (you will be redirected to Paypal payment site to complete the payment):

Patient First name:

Patient Last name:

Patient account #:

Amount: $

You may also call us to pay your bill. We are available by telephone from 8 - 5 Pacific time.

Phone: 800.944.3422

OR you may send us a fax with the payment information to 949-425-1738.

E-Checking Authorization Form    |    Credit Card Authorization Form