Pay Online

For your convenience, you may pay your Utah Valley Pediatrics balances online. This is a secure page and all information received is digitally encrypted.

*Patient Account Number
(on UVP statement)
 
Patient Name:
 
*Card Billing Address
 
*City
  
*State
  
*Zip
  
*Country
  
*Phone
   111-111-1111
Email
  
*First Name of Card Holder
  
*Last Name of Card Holder
  
*Type of Credit Card
 
*Credit Card Number
  (no dashes or spaces)
*Security Code
  (3 or 4 digit number)
*Card Expiration Date
  - (Mo/Yr)
*Charge Amount:
$
Comments
  
    I understand that by submitting this information, I authorize Utah Valley Pediatrics to withdraw the Charge Amount listed above from my account.  I also understand that this is a one-time transaction, as Utah Valley Pediatrics does not have access to the specific credit/debit card information entered here.  Automatic monthly payment plan withdrawals will need to be approved and set up through a Billing Account Specialist.  To set up an automatic withdrawal, please contact (801)374-8863.
 
   

 

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The material provided on this website and websites linked from this site is for informative purposes only.
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