Make A Payment Payments for variable cost products, treatments, & visits. Pay Your Balance Complete The Form First Name Last Name Phone/Mobile Email Payment Amount: Reason for Payment: I understand this a deposit for a prescription refill telehealth appointment. All information obtained is confidential. A patient intake form will be sent via email after confirmation of appointment and will need to be completed prior to the telehealth visit. On the day of your appointment login to https://doxy.me/angeleyescarePurchase