Online Payment Portal

Payer Information

Payer's Name

Email Address (for receipt)

Phone Number

Patient Information

Patient's Name

Record # (MRN as shown on statement)

Mailing Address

City

State

Zip Code

Payment Details

Payment Amount

Name as it appears on the Credit Card

Credit Card Information

Credit Card Authorization

I certify that I am an authorized user of the credit card provided above and authorize VITA Counseling Partners to charge my credit card for the amount entered.

Review & Submit

TRANSACTION APPROVED

TRANSACTION DECLINED

TRANSACTION PROCESSING

THANK YOU FOR YOUR PAYMENT!

THERE WAS AN ISSUE PROCESSING YOUR PAYMENT - PLEASE CONTACT US AT 855.826.8482, OPT 1

Palmerton Office

Easton Office

Online Payment Portal

Payer Information

Patient Information

Payment Details

Review & Submit

OUR MISSION:

OUR VISION:

USEFUL LINKS:

Registration Forms

Telehealth

Online Pay

Contact Us

OUR LOCATIONS:

Easton Office

3735 Easton-Nazareth Hwy, Suite 102

Easton, PA 18045

OUR LOCATIONS:

Palmerton Office

3295 Forest Inn Rd, Suite 3

Palmerton, PA 18071