Physicians Now Urgent Care Center
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Welcome to the Physicians Now Urgent Care Center Payment Page
Returning Payee? Log into your Physicians Now Urgent Care Center account to prefill your information.
Email Address:    *
Password:    *
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New Payee? Create a new Physicians Now Urgent Care Center account by placing an approved order.
One Time Payment Amount
Payment Amount:    *
Reference / Invoice:       (If applicable)
Billing Address
Full Name:    *
Address:    *
Address 2:  
City:    *
State:    *
(only required for US and Canada addresses)
ZIP Code:    *
(all numbers without spaces or dashes)
Country:    *
Phone Number:    *
(any format without spaces)
Email Address:    *
Password:    *
Confirm Password:    *
(8 characters, at least 1 alpha and 1 numeric)
   Save customer profile?
(Password is only required if checked)
Billing Information
Account Number:    *
(all numbers without spaces or dashes)
Visa MasterCard Discover
Expiration Date:       *
CSC:    *  What is CSC?
Special Instructions:  
  I agree with the Payment Terms and Conditions. *
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(please click only once to prevent duplicate orders)
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