Billing | Orthopedic Spine & Sports Therapy

Fill out the form below to pay your invoice. If you have any questions, feel free to give us a call at (248) 340‑1100.

Patient Information
Invoice ID*

Enter the invoice ID as seen on statement
Patient Name*
First Last
Card Holder Information
Payment Amount*
Email*

We will send a receipt to this email address
Phone*
Provide a phone number in case we need to contact you
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Name
This field is for validation purposes and should be left unchanged.

Patient Information