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
 
*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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