Payment Patient Name* First Last Office* OfficeBay Area Foot and Ankle SpecialistClear Lake Cardiology PLLCClear Lake HospitalistClear Lake OncologyClear Lake Pediatric ClinicClear Lake PodiatryClear Lake Primary CareClear Lake RehabClear Lake Specialties PAClear Lake Wound CareEndocrinology Clinic at CLSInfectious Diseases at CLSKidney Hypertension and Transplant ClinicKobayashi Diagnostics and TherapeuticMosaic ClinicNeurology Clinic at CLSS & S Foot Specialist PASleep Center at CLSSouth Texas Foot Specialist Customer ID Number*Amount* Invoice Number (For Televisit include TV followed by date of service and Provider First Initial and Last Name. Example: TV03182020JDoe)*Email* Phone*Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name CAPTCHA Resources Patient Portal Login Request an Appointment Insurance Billing & Assignment of Benefits Patient Financial Responsibility Missed Appointment Policy Patient Complaints and Concerns Request a Referral Request a Refill Get Lab Results