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 the patient's Medical Record Number (MRN like MM0000012345) as well as the patient's name and date of birth in the notes.

No Convenience Fee (FREE)

Pay by Check‚Äč - No Convenience Fee*

Pay By Check

Made payable to Bravia Dermatology Group, LLC
Mail to:

Bravia Dermatology
PO Box 876
Toledo, OH 43697-0876

Please write patient name, date of birth, and Medical Record Number (MRN like MM0000012345) in the check memo. 
*Please note that returned/canceled/insufficient fund payments will incur additional fees.  Please see our Financial Policy for additional details.

 

Pay Online with Credit Card, or Pay with Square Installments or CareCredit - No convenience fee*

We accept all major credit cards and debit cards.  You can Pay Online securely with the form in blue above or below this text.

Eligible patients may pay for cosmetic, medical, surgical, laser or other treatments in installments using Square Installments for Bravia Dermatology.  You may also pay for retail products and skin care products from Bravia Dermatology over time with Square Installments.  It works similar to a credit card.  Please visit https://squareinstallments.com/apply/bravi to read about terms and conditions.



You may also pay online with CareCredit.
Care Credit at Bravia Dermatology

*Please note that returned/canceled/insufficient fund payments will incur additional fees.  Please see our Financial Policy for additional details.

Phone Payment Convenience Fee

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).  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.

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

 

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 the patient's Medical Record Number (MRN like MM0000012345) as well as the patient's name and date of birth in the notes.