UNMC
Physical Therapy
Return-To-Sport Fee Payment Form
* Denotes required field
Payer's Information
*
First Name
Middle Initial
*
Last Name
*
E-Mail
*
Amount of Return-To-Sport Testing Fee
$
Credit card payments are charged a 2.95% surcharge.
You will also have the option to pay with an eCheck.
Please direct payment questions to:
Elizabeth Wellsandt at
elizabeth.wellsandt@unmc.edu
Type the text from the image into the space below.
Get a New Image
Visual Help...
Why...