Client Payments - Wendt Center

Please use this form to process your payment. When you click submit, you will be redirected to PayPal’s website to enter your credit card information and complete your payment. It is not necessary to have a PayPal account. Thank you.

Name*

First Last

Email*

Phone*

Therapist Name*

Date of Service*

Please enter date in the format of mm/dd/yyyy

Payment Amount*

Total