Online Bill Payment (OLD G-FORMS)

Online Bill Payment is easy:

-Input your Account Number from your statement
-Click Next

-Input your demographic information
-Select one time payment or installment plan
-Put payment amount in along with your Credit Card info
-Click Submit

If you do not receive a confirmation email, call our Business Office at (406) 238-5849, Monday-Friday, 8:30 a.m.-5:00 p.m. and confirm with our staff that your transaction was received.

*Required Field

Account Number*

Where can I find my account number?

Clinic Information
Clinic*
Account Number*

Where can I find my account number?
Patient Information
First Name*
Last Name*
Email*
Phone
Address

Street Address

City

State

ZIP Code
Payment Details
Payment Type*
- One Time Payment
- Installment Payment
If you are not able to pay your bill in full we offer a convenient installment payment option.

Follow the simple instructions below to setup your payment plan, If you have any questions please call our office at (406) 237-5849.
1. Input the total amount of your invoice in the "Amount Due" field
2. Select the number of months you would like to spread the payments out over from the dropdown menu (1 Payment per month)
3. Select the day of the month you would like to make future payments (the first payment will process today, if the day you pick lands on a weekend the payment will process the next business day)
Total Amount Due*

(enter digits only without comas)
Total Amount Due*

(enter digits only without comas)
Number of Payments

(one payment per month)
Monthly Payment Date
Payment Amount

Price: $0.00
Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code

Cardholder Name
Total
$0.00
Once you submit your payment please wait for the Confirmation page. Your receipt will be emailed to the email address provided above.

Online Bill Payment (OLD G-FORMS)

Clinic Information

Patient Information

Payment Details