make a payment

Simple, Seamless, and Secure

At Somerset Eye Institute, we strive to make our patients’ experience as easy and convenient as possible.

* 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*





Terms & Conditions

Privacy Policy

refund policy:

If you have made a payment via the online web portal, you may request a refund to your credit card for the following reasons:

  • Customer transaction error
    • Incorrect amount
    • Paying the wrong provider
    • Wrong credit card used
  • Duplicate payment

Click here to read our entire refund policy.