MAKE A PAYMENT Use the form here to submit a payment securely online. You may also call our office to make a payment by credit card over the phone. Basic Info Payment Confirm Basic Info Personal Information Invoice Number * Patient First Name * Patient Last Name * First Name * Last Name * Email * Next Payment Payment Information Payment Card Terminal Pay Credit Card Add New Card Please define in range Amount Please define in range Amount Pay With ACH Pay with Terminal Please define in range Amount I accept the no Previous Pay Now $ USD Payment Successful Thank you! Your payment to Nickel City Physical Therapy has been accepted. Thank you! Page will be redirected in 5 seconds.