Online Bill Payment

Use the following form to make a payment on an invoice received from our office. We hope it’s an added convenience for our patients.

Payment Form

Billing Information

Payment Information

Card Information


Your information is secure. Please review all fields before clicking submit.


West Salem Family Practice respects each individual’s right to personal privacy. We will collect and use information through our web site only in the ways disclosed here. This statement applies solely to information collected at

Data collected on this site is used only to facilitate communication with current and prospective patients. We use standard tracking tools to measure usage of our site; this does not include any personally identifiable information. West Salem Family Practice does not sell or share any information received from this web site.


We use professional software and strict internal protocol to ensure the privacy of transmitted data. For our online payments system, we use strong SSL encryption to protect your information in transit.


We may issue a refund in cases where an overpayment has been made in error. Please contact us if you feel this has occurred. Once approved, all refunds will be provided as a credit to the credit card used at the time of payment within five (5) business days.

If our policy on information collection or uses changes, we will immediately post revisions to this page. If you have any comments, questions or concerns with regard to West Salem Family Practice’s privacy policy, or the use of information submitted through this web site, please call 503.371.3232, or email us.