West Jefferson Urology Specialists Online Bill Payment

Please complete the form below.  Click on the Submit when finished.  We value your privacy.  Personal information will be used only for bill payment.  If you have any questions or would like to speak to a Billing Services Representative, please call (866)434-1545 ext 85294 .

Online Payment

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  1. Information From The Bill
* Patient First Name:  
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* Patient Last Name:  
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* Account Number:  
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* Daytime Phone Number:
 * Payment Amount:
Amount you are going to pay