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*Patient Full Name
*Mobile Number
*Consultation Date
*Preferred Consultation Time
   Terms & Conditions for Authorization for Online Payments: The West Bay Medicare online payment website is an on-line bill payment service for the consultation fee for our visiting physician.

  Terms Governing the Use of the Service. Please read these terms carefully before accessing or using the Service. By accessing or using the Service, you agree to be bound by the terms and conditions below:

   • If you do not accept the terms and conditions of this Agreement, you may not access or use the Service. West Bay Medicare may modify this Agreement from time to time, and such modifications shall be effective immediately upon posting of the modified Agreement.
   • Payment for Services. By submitting payments through the Service, you authorize West Bay Medicare to process your payment for the consultation fee.
   • Consultation fee for our visiting physician is not refundable as they will only be providing services in our center for a short period. You will be receiving a confirmation appointment once we will receive your request for consultation.
   • West Bay Medicare will not be responsible for any failure to process a payment authorization that is not actually and completely received by West Bay Medicare for any reason, including user error, equipment malfunction, natural disasters, or impediments, or inaccurate or incomplete information.

  Your Agreement. By clicking forward to make a payment, You Acknowledge that you have read and understand this agreement and you agree to be bound by the Terms and Conditions set forth above and any future amendments to this agreement which may be made from time to time.