Your medical home tracks your health history and illustrates important details about your unique needs. A Family Physician integrates your healthcare needs along with other specialists and physicians to create a comprehensive team assessing your health. You are respected and treated as a unique whole person with personalized care.

ONLINE PAYMENTS

Conveniently pay your bill online! We accept Visa, Mastercard and Discover cards. After we process this payment, your credit card information will be destroyed. This information remains confidential and our office respects your privacy.

I authorize Dr. Poonawala to charge to my credit card below and apply the payment to my account #_______________________:

Name of Patient account payment applied to___________________________

Type of Credit Card:       _____Visa      ____Mastercard      _____Discover

Name as it appears on card_________________________________________

3-Digit # on the back of your card:_____________

Card Number____________________________Expiration Date___________

Your Signature_________________________________Date_____________

_______Yes, please mail me a receipt to address:__________________________
                                                                              ___________________________
      _______No need to mail me a receipt                  ___________________________