Family Practice Medical Billing Services

A 3% processing fee will be applied to all credit card payments to cover transaction costs.

This fee does not apply to debit card, ACH, or check payments. Debit cards and ACH payments not accepted

Customer Name(Required)

First Last

Invoice #(Required)

Phone Number(Required)

Email Address(Required)

Enter Email Confirm Email

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Amount Shown On Bill(Required)

Payment Method

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

4649 Ponce de Leon Blvd., Suite 301 Coral Gables, Florida 33146

6900 Tavistock Lakes Blvd., Suite 400
Orlando, FL 32827