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Payment Options

We're offering more ways to pay. Starting in 2024, patients will have the option of paying monthly on the 1st of each month or paying per visit on the Friday before your appointment. 


Monthly billing includes all regular Followup Visits on a 4 week recurring schedule. Monthly billing will be billed on the 1st of each month at a rate of $245 per month. If more frequent or additional visits are required, extra visits will be invoiced as needed. 


Per visit billing will be billed the Friday before each visit at a rate of $225 per visit. 

Billing Preference & Credit Card Authorization Form

Your billing preferences will be updated based on your response to the following questions.

Starting January 1, 2024, a credit card must be saved on file and a credit card authorization form must be completed by the cardholder making payment. The information below will be saved to file for future transactions.


Please complete all fields. You may update your card on file at any time by completing a new form or by contacting our office. This authorization will remain in effect until cancelled.


The cardholder below authorizes payment for services rendered to the patient and for balances that may be owed in accordance with OnCall Pain's Financial & Office Policies.

How would you like to be billed?
Credit Card Type

Thanks for submitting! Your credit card information and billing preferences will be updated for visits on or after January 1, 2024.

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