Welcome To Pennsylvania Counseling Services
Client EasyPay Portal

This pay option is provided as a way to make it easy to make a payment on your account
without mailing a check or having to stop by the office to drop off a payment.

Please fill out and submit the below form to make a payment.

All fields marked with a (*) are required.

Payment Type

Please select the type of payment being made: *

   Payment for Services is a general payment toward the total balance due on your account.
   Payment for Medical Records is a payment toward your invoice for Medical Records.
   Payment for Polygraphs is a payment toward your invoice for Polygraphs.
   Subscription Fee

Client Information

Client First Name *

Client Last Name *

Client Date of Birth (in the format: mm/dd/yyyy) *

Clinic Location *

Carlisle PsychChambersburgColumbia PCSGettysburgHarrisburgLancaster CityLebanon HQLebanon RenaissanceLIVE UP CounselingPCS Harrisburg 17th StreetPottsvilleReading PsychiatricTelehealth PCSWest Shore (Mechanicsburg)WyomissingYork - George StreetYork Psychiatric

Additional Information

Payor Phone Number *

Name of person making payment (if different from client)  

Payment & Credit Card Information

Enter Amount in US Dollars($) *

First Name on Credit Card *

Last Name on Credit Card *

Street Address *

Street Address (Line 2)  

City *

State *

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code *

Accepted Credit Cards  

Credit Card Number *

Expiration Date (MM / YY) *

CVV *

NOTE: Your credit card statement will show the payment description as
PACounseling*OnlinePay