make a payment

Simple, Seamless, and Secure

At Somerset Eye Institute, we strive to make our patients’ experience as easy and convenient as possible. With our online bill pay option, you can securely and seamlessly make a payment for your service anytime.

* Required Field

Payment Information

Patient Name*

Payment Amount*
Amount to be paid (do not include $ sign)
$

Account Number*

Date of Service*(mm/dd/yy)

Additional Information

Billing Information

First Name*

Middle Name

Last Name*

Address*

Address 2

City*

State*

Zip*

Country

Phone Number

Email Address*

A receipt will be sent to this email address.


Payment Details

CVV/CVC Number, Please enter the 4-digit number for American Express, and enter the 3-digit number for all other cards.

Card Type*

Card Number*

CVV/CVC Number*

Exp. Month*

Exp. Year*


patients:

Each year, the surgeons at Somerset Eye Institute perform 9,000 ophthalmic procedures to NJ-area residents.

+ Patient Rights
+ Patient Rights (Spanish)
+ Patient Survey
+ Patient Survey (Spanish)
+ Pre-op Instructions