Submit a Payment – Rochester - Boston IVF Central New York

Online Payments

You can use this portal to make payments on existing statements or to submit payment on your account for future services. After entering your name and payment amount below, you will be redirected to our secure payment page, where you will be asked to complete a simple form to submit payment. We ask that you complete the requested information, including a valid e-mail address and daytime contact phone number.

PATIENT INFORMATION

Patient First Name:

Patient Last Name:

Patient Date of Birth:

Patient Account #:

Patient Billing Address:

City:

State:

Zip:

Contact Phone Number:

CARD HOLDER INFORMATION

SAME AS PATIENT

Card Holder First Name:

Card Holder Last Name:

Card Holder Billing Address:

City:

State:

Zip:

Contact Phone Number:

REASON FOR PAYMENT

Payment on Account Balance

Pre Payment

Other

Enter Amount

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