Patient Payment Form
Enter your patient number on the invoice
First name
Last name
Billing Address
Billing Address
Street Address
Street Address Line 2
State / Province
Postal / Zip Code
Credit Card
Credit Card

Refund / Return / Cancellation Policies

Our Commitment to You:
American Medical Associates will safeguard the confidentiality and the security of the information we obtain from you. This notice describes our privacy policy as it relates to the collection, protection of such information resulting from credit card transactions only.

Collection of Information:
American Medical Associates will collect and use information obtained from credit card transactions only for business purposes. These purposes include the payment of deductibles, co-insurance, copayment or outstanding balances on your account.

Protecting Your Credit Card Information:
The credit card information provided by you to American Medical Associates will be stored in a confidential manner. Our employees may access such information only when there are appropriate business reasons to do so, such as those stated above. We maintain physical, electronic and procedural safeguards to protect your information, and our employees are required to follow these privacy standards.

Terms & Conditions For Online Payment:
American Medical Associates will not be held responsible in the event your electronic message is not transmitted due to technical problems related to this site or to the hosting server. All personal identifying information is encrypted and your message will not be internally or externally forwarded to other third parties.

We do not accept returns through this site, and refunds will not be issued to the credit card. To request a refund or credit, please contact American Medical Associates directly at (480) 306-5151. Any adjustments will be issued as credit to the patient account or as a check.

Your request will generally be processed within 1 business day, during normal business hours, excluding holidays.