ONLINE PAYMENT FORM


   STEP 1. ← Enter the amount you wish to apply to account balance.
   STEP 2.  ← Click or tap this box to go to payment portal.

 


To ensure your payment is applied to the correct account, please include your invoice number (if available) as well as the patient's name and date of birth in the notes (if different from the cardholder).

Please note: Due to software limitations, the convenience fee charged for balances >$100 will be listed at checkout as a “Shipping Fee”.

Convenience Fees

Credit card processors charge a larger fee for charges processed when the card is not present at time of authorization (i.e. charges made over the telephone or online).  These fees can exceed 4%.  Due to these increased fees and additional costs associated with processing such charges, bravia dermatology will add the following convenience fees for such “card not present” charges.  Please understand this convenience fee does not recover all of the fees bravia dermatology incurs for such charges.


Online Payment Convenience Fees
Convenience fees are discounted by 50% if payments are made via online portal.  Please note: due to software limitations, the convenience fee will appear as a “Shipping Fee”.  For those with balances >$100 who do not wish to incur any convenience fees, payments made by check do not incur any convenience fees. 

Charged Amount (Online Payment) Convenience Fee (Online Payment)
$0.00 to $100.00 No Fee
$100.01 to $300.00 $2.50
$300.01 to $500.00 $3.50
$500.01 to $1000.00 $5.00
$1000.01 and up $10.00

 

Over-the-phone Payment Convenience Fees
(Call 419-948-3376 to speak with billing to make a payment over the phone)

Charged Amount (Phone Payment) Convenience Fee (Phone Payment)
$0.00 to $100.00 $2.50
$100.01 to $300.00 $5.00
$300.01 to $500.00 $7.00
$500.01 to $1000.00 $10.00
$1000.01 and up $20.00

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Paper Check - No Convenience Fee

Made payable to Bravia Dermatology Group, LLC
Mail in or Drop Off to:

Bravia Dermatology
Attn: Billing
2000 Regency Ct #201
Toledo, OH 43623

Please write Invoice number and/or patient name and date of birth in the check memo.

Online Payment Form


   STEP 1. ← Enter the amount you wish to apply to account balance.
   STEP 2.  ← Click or tap this box to go to payment portal.

 


To ensure your payment is applied to the correct account, please include your invoice number (if available) as well as the patient's name and date of birth in the notes (if different from the cardholder).

Please note: Due to software limitations, the convenience fee charged for balances >$100 will be listed at checkout as a “Shipping Fee”.