Online Payment - Liberty Doctors

Did you receive an invoice in the mail? Use your credit card to submit a payment to Liberty Doctors.

Patient Info and Payment Amount
Patient Name*
First Last
Enter the Patient's Name here. Note that this may be different than the payer's name, which you will enter below.
Patient's Date of Birth*
Date Format: MM slash DD slash YYYY

Enter the Patient's Date of Birth
Patient ID (found on your statement)*
Type "none" if you do not have access to your statement.
Dollar amount you would like us to charge to your card today*
Credit Card and Billing Information
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
We will contact you at this number if we have any questions in regards to your payment.
Email*

The payment receipt will be sent to this email address.
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Comments
This field is for validation purposes and should be left unchanged.

Patient Info and Payment Amount