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Santa Barbara Eyecare

Secure Payment Form

             
Patient First Name
Patient Last Name
Patient Account #

Your account number can be located toward the top right of your statement.

Email Address

A payment receipt will be sent to the email address provided.

Phone Number

Please provide the best contact phone number to reach you at.

Amount Due

Please enter the total amount due as reflected on your statement.

Please click the button to the right if you prefer to pay via e-Check.
Pay By Check
Name as on Card
Card Number
Card Expiration Date
CVV (aka Security Code)
Billing Street Address
Billing ZIP Code
Please click the button to the right if you prefer to pay via Credit Card.
Pay By Credit Card
Name as on Check
Bank Routing Number

Please double check routing number is correct before submitting.

Bank Account Number

Please double check account number is correct before submitting

You can also make a payment by calling us at (805) 967-9990. Monday - Friday; 7:30 AM - 4:30 PM