Please complete ALL fields in this form, then click on submit to process your payment.


Click "submit" only ONCE. Clicking multiple times may result in being charged additional times.

After clicking "submit" please wait to see your confirmation message. If you do not see a confirmation message, or receive an error, please call the Noyes Health Business Office at (585) 335-6038 for assistance.

Patient Account Information

The patient account information can be found on your bill in box #9 and the amount due can be found in box #25 (view a sample bill). If you have any questions or if you cannot find your account details please call the Noyes Health Business Office at (585) 335-6038.

Please input the account number of the patient whose bill you are paying.

Where can I find this?

Please input the name of the patient whose bill you are paying.

First Last

Payment Details

  (xxxx.xx)

Credit Card Information

  • Visa
  • MasterCard
  • Discover
  what is this?

Credit Card Billing Address


Review the information above, and click "submit" to send your payment.


Click "submit" only ONCE.
Clicking multiple times may result in being charged additional times.

After clicking "submit" please wait to see your confirmation message.
If you do not see a confirmation message, please call the Noyes Health Business Office at (585) 335-6038.