Make A Payment

Please use the form below to make a secure, online payment.

Name of Client*
First Last
Name of Payer (if different than client)
First Last
Billing Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Payment
Please enter the amount you wish to pay.
Client Account Number

Please enter if known
Enter the amount to pay*

Credit Card

Cardholder Name

Card Details

Total
$0.00

The Silverlinings Telehealth website uses SSL (secure sockets layer) to establish a secure connection to our credit card processor for all transactions.