Make A Payment

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Payment Form

- Step 1 of 2

Patients Name *

First

Last

Please specify the patients name here.

Email *

Date Of Birth *

Phone Number *

What is the payment for? *

Payment Amount *

Name *

First

Last

Total of Payment

0,00 €

Credit Card Details *

Card

Name on Card

Note: Payments are handled by Stripe payment gateway, Rathangan Medical Centre do not hold card details of customers.

Rathangan Medical Centre,
New St,
Rathangan,
Co. Kildare,
R51 CY51
Tel: 045 528088
Fax: 045 528108