Make a Payment

(For Mountain Valley Therapy patients only)

Instruction for Online Payment Procedure:

Please fill out the form below. Upon clicking the “MAKE A PAYMENT” button, your information will be taken to a secure external site, where you will input additional payment information. There will be an option to print a receipt upon payment completion.

Thank you for using our free online payment service!

Payment Form



Cardholder Full Name

Cardholder Phone Number (format = xxx-yyy-zzzz)

Cardholder Email

Cardholder Billing Address

Cardholder Billing Zip

Patient Name and Account Number

Amount (format = 00.00)

Payment Form



Cardholder Full Name

Cardholder Phone Number (format = xxx-yyy-zzzz)

Cardholder Email

Cardholder Billing Address

Cardholder Billing Zip

Patient Name and Account Number

Amount (format = 00.00)

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2519 Cove Avenue
La Grande, OR 97850
(541) 962-0830

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