Please use your name and patient ID as the reference number below
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Surcharges may apply
Surcharge Details
What is CVN
Where can I find my Card Verification Number?
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3 digits located on the back of your card |
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4 digits located on the front of your card |
Review Details
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Direct Debit Request
Sign up is completed and the first payment is processed.
Thank you for signing up to this payment plan. Below is the receipt for the first transaction and the detail for the payment plan sign up.
| You have paid | |
| Amount paid today Amount to pay today | |
| Total amount today (inc. surcharge) | |
| Total amount today | |
| Total amount today | |
| Card number | |
| Expiry date | |
| Cardholder name | |
| Payment method |  |
| Payment method | |
| Payment method | |
| BSB number | |
| Account number | |
| Account name |
Detail for the payment plan sign up
| Total amount | |
| Payment plan option | |
| Next payment | |
| Next payment date | |
| No. of remaining payments | |
| Remaining amount to pay |