Secure Online Payments

Payment Information

Contact / Shipping

Billing Address

Billing

what's this?

I affirm that the information entered on this form is true and correct and further declare that I have read, understand and accept Polaris Family and Sport Chiropractic Inc. Terms as referenced in the [Terms of Use] link below.

Polaris Family and Sport Chiropractic Inc.
9383 S. Old State Road Lewis Center, OH 43035
(614) 846-2225

To protect your client's privacy, our secure server uses secure socket layer (SSL). This ensures that the billing information is encrypted and cannot be read as this information is transferred over the internet.