PAYMENTS
If you wish to pay on an existing account via credit card, please feel free to utilize this page! We accept MasterCard, Visa and Novus(Discover). Please fill out the boxes below and and click "send" when finished. We will print this off in our office and attach it to the payment for our records.

Credit Card Number

Amount

Exp.Date


MasterCard     Visa        Discover
Name of Card Holder
Patient Name




E-Mail Address

Your questions and comments are welcome!

 


Home | Physicians | Services
Newsletter | Patient Survey | Payments
Notice of Privacy Practices
Clinic History


© Broken Bow Clinic, P.C., 2008