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Billing details

Patient Information

Parent Information

Payment Information

Terms & Conditions

I authorize Metropolitan Pediatrics, LLC, to charge my debit or credit card the Payment Amount indicated on the online bill pay form. I acknowledge that I am responsible for entering the correct Payment Amount and all other required information, and that I am initiating a charge to my card compliant with U.S. law. By submitting an online payment, I agree that I possess funds sufficient to cover the Payment Amount entered, and agree that Metropolitan Pediatrics, LLC, is not liable for any overdraft or insufficient funds penalties. I understand that it may take several business days for an online payment to be processed and applied to my account.

Total

Product Subtotal
Online Payment  × 1 $0.00
Subtotal $0.00
Total $0.00