Payment

Atrium Family Practice Online Payment Form

This form is for one time payments only for appointments and services on behalf of the Atrium Family Practice. Please contact the Practice if you need any help or assistance with making your payment. Thank you for your custom.

"*" indicates required fields

There are 2 ways you can make a payment.

Option 1: Request a Payment Link from the surgery to your phone. You will click on that link and make your payment.

OR

Option 2: Complete the form below to make your payment.

Request Payment Link From Atrium Family Practice.

Patient Name*

First Last

Date Of Birth*

Phone*

Email*

PAYMENT SECTION

Please Note: A receipt will be sent to your email address upon payment.

Do you have a valid in-date medical card?*

Yes

Please choose one service (Medical Card Holder)*

Please choose one service(Non-Medical Card Holder)*

Hidden

Quantity*

Total Amount

Hidden

How would you like to pay?*

Online

By cheque

By phone

Payment by Credit/Debit Card Call Mon - Fri 9am to 6pm xx-xxxx-xxx-xxx ask for Membership Renewal.

Cheque payable to Family Lawyers : The Law Library, Four Courts, Inns Quay, Dublin 7, D07 N972

Stripe Payment

Card Details

Cardholder Name

Atrium Family Practice Online Payment Form

There are 2 ways you can make a payment.

Request Payment Link From Atrium Family Practice.

PAYMENT SECTION

Section Break

Title

Cervical Smears- no excuses!

Make a Payment

Atrium Family Practice Online Payment Form

There are 2 ways you can make a payment.

Request Payment Link From Atrium Family Practice.

PAYMENT SECTION

Section Break

Title

Cervical Smears- no excuses!