WALK-INS WELCOME

Payment for Briggs / Southwest

Please enter all required information on this form to make a payment for Briggs / Southwest.

Account Number*

Patient First Name*

Patient Last Name*

Organization

Address*

Address2

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Phone*

Fax

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Amount*

Notes or Special instructions*

Total Amount

Payment method

Credit Card or Paypal

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

Verification code*

Patient Portal

We offer same day appointments for your sick child.

No one chooses when a child gets sick, but with several locations around San Antonio, we have convenient hours to suit your needs.

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