Patient Notebook

OMPT Specialists

29255 Northwestern Highway

Suite 300

Southfield, MI 48034

Phone: (248) 353 - 1234

Website: www.ompt.com

Make a Payment

Need to make a payment? Please fill out the information below and hit continue.

Error Summary

Please, correctly fill out all required fields.

1. Patient Information

First Name *

M.I.

Last Name *

Patient Account Number

Patient Date of Birth *

Email Address

A receipt will be sent to this email address.

2. Payment Amount

Amount

3. Payment Method

Credit/Debit Card

Bank Account

Name on Card *

Card Number *

Expiration Date *

Security Code *

Zip Code *

Cancel

P (248) 353 - 1234

W www.ompt.com

29255 Northwestern Highway Suite 300

Southfield, MI 48034