✓
Intake2
Payment3
ConfirmedAppointment Details
Patient
—
Service
—
Appointment
—
Insurance
—
Charges
Total Due Today
$0.00
Charge Date
—
Appointment Date
—
Card on File — We'll securely store your payment method. You'll only be charged after your insurance is processed and your responsibility is determined. No surprise charges.
Payment Method
Your card information is securely processed. We never store your full card number.
By completing this payment, you authorize HeyAllergy to keep your card on file for this visit and any subsequent follow-up balances. Payments are approximations based on insurance benefits; a residual balance or refund may apply after claims are finalized.
256-bit SSL encrypted · PCI DSS Compliant · Powered by accept.blue
VisaMastercardAmexDiscover
Payment Successful!
Your payment has been processed and your card is securely saved on file. Please complete your new patient paperwork to confirm your appointment.
Confirmation—
Card—