Payment Portal - Overlake Reproductive Health

Please use the following secure form to make a payment to your account. Any overpayments on your account are refunded within 30 days of refund request. To set up your monthly cryo storage payments please use embryo options.

Card Holder Details
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Phone
Payment Details
Name on the Account*
First Last
Payment will be applied to this account
Patient Account Number
Found on your statement
Account to apply payment towards*
- Clinic Account (act # ____.9)
- Lab Account (act # ____.12)
- Unsure
Help us process your payment more quickly by indicating which account you would like this payment to be applied towards. You can identify the account by looking at your statement and identifying the trailing numbers on your account number. Clinic accounts have a trailing 9 (i.e. ____.9), while lab accounts have a trailing 12 (i.e. ____.12). If you are unsure please select 'Unsure'.
Payment Amount*
Total
$0.00

Card Holder Details

Payment Details

Bellevue Fertility Clinic

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