North Georgia Foot & Ankle Specialists


Online Bill Pay

Complete the form below to send your billing information to North Georgia Foot & Ankle Specialists. Your credit card will be processed at our office. Please complete all fields in the form below.

Transactions will be processed within 2 business days and you will receive an email confirming that your transaction has been completed.
Patient First Name:
 Patient Last Name:
 Account Number:
Address:
 City:
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 Zip/Postal code:
E-mail Address:

Please enter a valid e-mail address.		 Phone number:

Please supply your phone number.
Payment Amount Payment Method: Card Number: Expiration Date:
$   
Name On Card: Billing Address City State Zipcode
Comments:

Can North Georgia Foot & Ankle Specialists leave your credit card information on file?    Yes   No
   
  



   

 

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