Secure Payment

Pay your bill online using the form below. Please note that this form can only be used to make payments for services rendered by Anisa Woodall, Catherine Southworth or Drs. Rian Shah, Tiffany Althaus, Mark Woodall, Amy Olsen, and Cristina Covert as well as service provided by the Center for SIBO Testing.

Please do not submit payments for Dr. Alexandria Easter using this form.

Billing Information
First Name*
Last Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Email*
Enter Email Confirm Email
Payment Information
Patient Name*
Only one patient per payment is allowed.
Statement Number
If paying for more than one statement, please list all statements separated by commas. For example, 172, 909, 1227. If you don't have a statement, leave blank.
Payment Amount*

Please enter the payment amount (for example, $25.50 or 25.50)
Credit Card*

American Express
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Visa
Card Number Expiration Date Security Code Cardholder Name

Secure Payment

Billing Information

Payment Information