CONVENIENT ONLINE PAYMENT OPTION

Name: CONVENIENT ONLINE PAYMENT OPTION
SKU: 865
Price: 1.00 USD
Availability: InStock

Welcome to our secure, online payment portal. Patients may use this option to make payments on existing invoices or to pre-pay for upcoming treatments or services. You may also use this option to pay for storage fees related to cryopreservation of embryos, eggs, or sperm.

If you have any questions regarding your medical bill, please contact our Patient Accounts Team by calling 732-447-9515 or 732-447-9516. You can also email them at: PatientAccounts@InfertilityDocs.com.

Billing details

Patient First Name: *

Patient Last Name: *

Patient Date of Birth: (optional)

Country *

Patient Billing Address: *

Town / City *

State / County *

Postcode / ZIP *

Phone *

Patient Email: *

Your order

Product Quantity	Total
Cart Subtotal	$0.00
Order Total	$0.00

Credit Card

Pay securely using your credit card.
Card Number *
Expiration (MM/YY) *
Card Security Code *
eCheck

Pay securely using your checking account.
Routing Number *
Account Number *
Account Type *
I authorize Infertility Docs to use information above to initiate an electronic fund transfer from my account or to process the payment as a check transaction or bank drawn draft from my account for the amount of $0.00. If my payment is returned due to insufficient funds, I authorize Infertility Docs to make a one-time electronic funds transfer or to use a bank draft drawn from my account to collect a fee as allowed by state law.

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Your personal data will be used to process your order, support your experience throughout this website, and for other purposes described in our privacy policy.