Secured Online Payments

Home » Secured Online Payments

Please fill in your payment details, and simply submit. Payment confirmation email will be send to email account provided in the form below.
Amount to pay*

Please enter the amount to pay, like: €125.50
Email Address*
First Name*
Last Name*
Billing Address*
Address Address Line 2 City County Postal Code Country
Total to be charged:
€ 0.00
Credit Card
Card Details
Cardholder Name

P: 056 7786211
E: contact@kilkennyphysiotherapy.ie
A: City Physiotherapy & Sports Injury Clinic
Sandy Ridge, Bleach road, Kilkenny. R95 KP83