Please fill out all of the form fields below to submit your payment.

  • Please select the Standard Rate above unless you have already made arrangements with Horizon Health and Wellness for the Pre-Approved Rage. Failure to select the correct rate may prevent you from being tested at your selected appointment time.
  • Please enter a number from 1 to 9.
  • This page is unsecured. Do not enter a real credit card number! Use this field only for testing purposes.
    American Express
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