Patient services

Valley Neurology Group Payment Plan

Split your balance into scheduled, automatic payments

Your first payment is charged today; Square securely saves your card and bills the rest on the schedule you choose until the balance is paid in full. Payment does not confirm insurance coverage or an appointment.

RECURRING PAYMENT PLAN

Valley Neurology Group Payment Plan (Recurring Payments)

Split a balance into scheduled payments. Your first payment is charged today; Square bills the rest automatically until the balance is paid.

A payment plan is paid by credit or debit card only — Square securely saves your card and automatically charges each scheduled payment. (Apple Pay, Google Pay, Cash App Pay, Afterpay/Clearpay and bank/ACH are available for one-time payments.) Square emails a receipt after every payment. Keep your receipts. If you are unsure whether a payment succeeded, contact our office before paying again. We never ask you to send card details in email or chat.

SSL Secured256-bit EncryptionHIPAA-AwareSquare Secure GatewayCard details are encrypted and processed by Square. This site never stores your full card number.

Submitting this form does not confirm payment until the payment has been posted and cleared. For follow-up, please call (661) 776-3876 during office hours: Monday–Friday, 8:30 a.m.–5:30 p.m. PST.

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Card details are processed by Square. Your patient and billing details are saved to our private office payment record through Jotform.

Recurring payment plan disclosure. By setting up a payment plan you authorize Valley Neurology Group to automatically charge your saved card for each scheduled payment on the agreed dates until your total balance is paid in full. Your first payment is charged today at submission. Square emails a receipt after every payment. The agreed amount, frequency and due dates are enforced for every payment until the balance is paid. To change the amount, frequency or card, or to cancel, call our office at (661) 776-3876 before your next scheduled date. A payment plan is paid by credit or debit card only.

Submitting this form does not confirm payment until the payment has been posted and cleared. For follow-up, please call (661) 776-3876 during office hours: Monday–Friday, 8:30 a.m.–5:30 p.m. PST.