Secure Online Payments



Please begin by entering your Statement ID and Guarantor DOB



   If your statement ID looks like this (Six sections, five dashes):
Statement ID:    - - - - -
 
OR   
 
   If your statement ID looks like this (Four sections, three dashes):
   - - -
 
 
Guarantor Date Of Birth:    (Use patient's DOB if no guarantor available)
 
 
Security Check: