Make a Payment Pay Online "*" indicates required fields Name of Person Paying* First Last Patient's Full NameEmail* Payment for*– Select One –Residential ProgramDH7 ProgramAddiction DetoxificationAddiction CounsellingIndividual CounsellingFamily CounsellingCo-pay- ResidentialCo-pay. DH7Day ProgramOutpatient intensivePsychology consultationPsychiatry consultationAssessment- Nurse/PsychiatristAssessment- NurseAssessment PsychiatristOccupational TherapyCommentsPayment Amount* Total Credit/Debit Card Information* MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name Disclaimer* All payments must be confirmed prior to the individual’s arrival for their appointment.