Pay My Bill
This form is via a secure platform and is HIPAA compliant. Please note that our credit/debit card option is currently not working. PayPal is still accepted.
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Payment Amount
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( X )
USD
Nutrition Consulting Fees
Payment Methods
Debit or Credit Card
Please click one of the PayPal options to complete payment and
submit
the form.
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