Skip to content
Home
Pay Occupational Medicine Invoice
Occmed Payment
Step
1
of
2
50%
Hidden
Visit ID
Hidden
Company Lookup
— Select Company —
– Fill Out Other Fields –
Hidden
Section Break
Company text Phone
(Required)
Company Email
(Required)
Hidden
Insurance or Cashpay fees for Telemed Visit
(Required)
Hidden
Calculated other total
Hidden
Pay Balance Due or Other Balance
Pay Balance due of
Pay different amount
Hidden
Amount to pay
Fee Increment
Price:
Total Charges to be Collected
Hidden
Credit card number
Secure Credit Card Payment
(Required)
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
Security Code
Cardholder Name
By typing my name below, I authorize this transaction
Hidden
end credit card number
