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Pay Your Bill Online

You can securely pay your Retina Associates bill online using the form below. To get started you will need a recent bill


  1. All fields in the form are required, so fill the form out completely.
  2. Enter your account number into the "Account Number" field exactly as shown on your bill. 
  3. In the "Amount" field, enter the amount you wish to pay in the format 1234.50 (do not include the dollar sign, commas, or characters other than numbers and the decimal point).
  4. Click the "Continue" button.
  5. You will be directed to the Retina Associates secure payment gateway page where the rest of your information will be collected and the transaction will be completed.
  6. If you enter an email address on the payment gateway page, you will receive an emailed receipt.


Payment Form

First Name:
Last Name:
ZIP Code:
Account Number:

Enter your account number as it appears on your bill.
Patient Name:

Enter the name of the patient for whom the bill is being paid.
Payment Amount ($):

Enter the amount you would like to pay in the form 1234.00
(Use only numbers and two decimal places - no dollar sign).