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MI
 
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  Notes

 
 
Credit Card Transactions: By submitting payment information through this service you agree to the terms and conditions of this agreement and any documents incorporated by reference. You are authorizing a charge on your credit card and you further agree that this user agreement forms a legally binding contract between you and TMH Physician Organization and this agreement constitutes a writing signed by you under any applicable law or regulation. Any rights not expressly granted herein are reserved by TMH Physician Organization. Partial payment does not reflect a payment in full. You are responsible for the full amount of the balance due.

Checking and Savings Transactions: By submitting payment information, you are authorizing TMH Physician Organization to reproduce this item as an ACH Transaction for deposit on the date specified above. This means that the amount specified will be debited from your account. A transaction that is returned to TMH Physician Organization for any reason (such as insufficient funds) is subject to a returned item fee in the amount of $20.00. An ACH transaction will be produced utilizing the information from this form you are submitting. Partial Payment does not reflect a payment in full. You are responsible for the full amount of the balance due.

Payments made to your account may take up to 48 hours to post.

If you need to arrange a payment plan, please contact TMH Physician Organization at (713) 441-4347 during standard business hours M-F 9:00am-4:00pm CST.


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