Payor Name
Patient's Birth Date
To make a secure online credit card payment simply enter your information in the fields below, then click on the "Make Payment" button. You will be transferred to our secure Bank of America Credit Card processing page (all fields must be completed prior to being transferred to the card processing page).
Your credit card statement will reflect a billing from WCSI-Secure for this transaction. WCSI-Secure is our secure payment processing operation that handles all of our online credit card payments.
Please take note of this so that you will be able to recognize this charge on your next credit card statement.
Once your payment has been confirmed, you will receive an e-mail confirming your payment.
Thank you for using our Secure Online Credit Card payment system.
(This online payment feature is available for the Coastal Dental Services’ Southside Office only)
Payment Amount
Payor Email Address
Payor Phone Number
Patient's Name or Account Number:
