To pay your account online, please fill in and submit the following formName of patient* First Last Date of birth of patient*Email* Enter Email Confirm Email Phone*Payment amount* Credit Card payments are currently not processing due to an error. You can order your prescription above and make a manual payment using the following details: Bank: BNZ, Hamilton East Account Number: 02 0342 0009339 00 Please use patient DOB and name as your reference.MessageCommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
