Make a Payment with a Credit Card or a Debit Card

If your patient guarantor number is seven digits (XXXXXXX), please click here to submit your payment through MyChart.

If your patient account number is eight digits (XXXX-XXXX), please use the form below to submit your payment.

If you have any questions about your bill or wish to update your insurance, contact us by calling 919-537-3940 or email us at ASOD_PBS@unc.edu.

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Patient Statement Example

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Instructions: Please provide the following information as found on your patient statement (see the above example) to ensure that your payment is properly credited:

Payment Information

* Required Fields

Patient First Name (Must match first name on statement):*
Nombre del Paciente (Debe ser el mismo nombre que en el estado de cuenta):

Patient Last Name (Must match last name on statement): *
Apellido del Paciente (Debe ser el mismo apellido que en el estado de cuenta):

Patient Account Number: *
Numero de Cuenta del Paciente:

Payment Amount: *
Monto del Pago: $

Additional Comments:
Comentarios Adicionales:

Contact Information

* Required Fields

Your Name (Payor):*
Tu Nombre:

Your Contact Phone Number: *
Numero de Telefono:

Instructions: Click on the Submit Button below to be taken to our external payment processor website (Touchnet) to complete your Credit Card Payment: