logo

Normandale Chiropractic Health Center

Secure Patient Payment Portal

   
𝚃𝚎𝚡𝚝 '𝙱𝚊𝚕𝚊𝚗𝚌𝚎' / 𝚈𝚘𝚞𝚛 𝚀𝚞𝚎𝚜𝚝𝚒𝚘𝚗 𝚝𝚘: (𝟴𝟯𝟯) 𝟲𝟲𝟬-𝟰𝟱𝟬𝟵 o𝚛 𝙲𝚊𝚕𝚕 𝚝𝚑𝚎 𝙵𝚛𝚘𝚗𝚝 𝙳𝚎𝚜𝚔 𝚊𝚝 (𝟵𝟱𝟮) 𝟴𝟴𝟭-𝟱𝟳𝟬𝟯
*𝗣𝗔𝗧𝗜𝗘𝗡𝗧 𝗡𝗔𝗠𝗘

*𝗗𝗔𝗧𝗘 𝗢𝗙 𝗕𝗜𝗥𝗧𝗛
*𝗣𝗔𝗬𝗠𝗘𝗡𝗧 𝗔𝗠𝗢𝗨𝗡𝗧
*𝗖𝗔𝗥𝗗 𝗛𝗢𝗟𝗗𝗘𝗥 𝗡𝗔𝗠𝗘

*𝗖𝗔𝗥𝗗 𝗡𝗨𝗠𝗕𝗘𝗥

At this time we *DO NOT* accept AMEX or DISCOVER Cards. We apologize for any inconvenience!

*𝗘𝗫𝗣. 𝗗𝗔𝗧𝗘
*𝗖𝗩𝗩
𝗘𝗠𝗔𝗜𝗟 (if you want a receipt)
Keep Card on File?

Please Select 'Yes' If You'd Like This Card Kept on File For Your Account. *𝗪𝗲 𝘄𝗼𝘂𝗹𝗱 𝗿𝘂𝗻 𝘆𝗼𝘂𝗿 𝗰𝗮𝗿𝗱 𝘄𝗵𝗲𝗻 𝘄𝗲 𝘀𝗲𝗲 𝘆𝗼𝘂𝗿 𝗯𝗮𝗹𝗮𝗻𝗰𝗲 𝗵𝗮𝘀 𝗽𝗼𝘀𝘁𝗲𝗱 / 𝗶𝗻𝘀𝘂𝗿𝗮𝗻𝗰𝗲 𝗽𝗿𝗼𝗰𝗲𝘀𝘀𝗶𝗻𝗴 𝗶𝘀 𝗰𝗼𝗺𝗽𝗹𝗲𝘁𝗲 (𝗰𝗵𝗼𝗶𝗰𝗲 𝗼𝗳 𝗿𝗲𝗰𝗲𝗶𝗽𝘁 𝗳𝗼𝗿 𝗮𝗳𝘁𝗲𝗿 𝗿𝘂𝗻𝗻𝗶𝗻𝗴 𝘆𝗼𝘂𝗿 𝗰𝗮𝗿𝗱 𝗯𝗲𝗹𝗼𝘄)

Card on File - Receipt?

Please Select 'Yes' If You'd Like A Receipt Emailed 𝙒𝙝𝙚𝙣 𝙔𝙤𝙪𝙧 𝘾𝙖𝙧𝙙 𝙤𝙣 𝙁𝙞𝙡𝙚 𝙞𝙨 𝙍𝙖𝙣