MedicsPremier - Patient Portal

Patient

11140 Rockville Pike
Suite 450
Rockville, MD 20852

One Bank Street
Suite 220
Gaithersburg, MD 20878

Welcome to the Online Patient Payment System

Our medical office has the ability to accept secure online credit card payments through the Advanced Data Systems payment portal. After your information is verified directly with our practice records, you will be prompted to enter your credit card details along with a payment amount.

Proceeding indicates you have read, understood, and accepted our Privacy Policy and Terms of Service.

If you have any questions regarding your billing statement, please contact us directly at: 877-331-0044

Verify Patient Information

Step 1
Patient Information

Please type in the patient's information as found on the billing statement.

Account Number on Statement:*

Patient's Date of Birth (MM/DD/YYYY):*

E-mail address:

(Optional)

This information is used to verify that the account number entered above belongs to you or an immediate family member. By verifying the patient's data matches the provided account number, the possibility of an erroneous payment is minimized.

Collections

Collection Balance:

Credit Card Information

Card on File: N/A

Step 2
Credit Card Information

Patient Bal: $0.00

In the form below, please type in the credit card holder's information.
Use Card on File

First Name:

Last Name:

Street Address:

Zip Code:

Credit Card Number:

div id card-number

Expiration Date (MM/YYYY):

div id expiration

Card Verification Value:

div id CVV

Credit Card Number:

Card Verification Value:

Expiration Date (MM/YYYY):

Store this card for future use

Payment Amount:

How is my information secured?

- This website uses Transport Layer Security (TLS) to encrypt data between your computer and our servers.

- Your account information is verified with the doctor's office prior to submission in order to eliminate the possibility of erroneous payments.

- In partnership with Global Payments Inc. your credit card information is passed directly to the credit card processor and never accessible by Advanced Data Systems or the medical practice.

Online Payment Confirmation

Thank you for your payment!

Your payment in the amount of ${amount} was successfully processed on {timestamp}. The reference number for your transaction is {reference}.

{patient_name} - {acctpat_no}

Online Bill Payment - {auth_code}

Total

${amount}

This payment has been successfully posted to your account.

Questions?

If you have any questions regarding your payment, please contact the office directly during regular business hours. Thank you!

Montgomery Eye Physicians and Surgeons
Tel: 877-331-0044
This e-mail was sent from a no-reply address.