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Latest News
Click here to read our Vaccine Policy

Now Hiring - Certified Medical Assistant

 
 

Vaccine Study Information
Click here for information on Vaccine Studies in conjunction with University of Md.


 

Five Things Physicians & Patients Should Question
Click here to read this publication from Choosing Wisely and the American Academy of Pediatrics.

 

Online Billing

All fields with an * must be filled out for the payment to be processed.

Credit Card payments are not online transactions, only submissions. They are processed in our office within 3 buisiness days and credited to your account. If you would like a receipt mailed to you, please indicate this in the comments field.

Information
*Parent Name:
First Last

*Child's Name:
First Last

*Child's Date of Birth:
Month: Day: Year:

*Acount Number:

*Phone #:

*Email Address:

Payment
*Amount: $

*Billing Address:

*City: *State: *Zip:

*Name on Card:

*Credit Card Type:

*Credit Card #:

*CVV2 Number:
This is the 3-digit code is located on the back of your card, inside the signature area. Typically the signature panel will have a series of numbers, but only the last three digits make up the CVV2 code.

*Expiration Date:
Month: Year:

Comments:

 

All information submitted with this form is secured to The Pediatric Center with 128-bit encryption.

 

 

  1475 Taney Avenue | Frederick, MD 21702 | phone 301.662.0133 | fax 301.695.8604 | © 2007