Bold = required
Payment Details
Statement Number
Responsible Party
Total Amount
$
$ 
Description MIT Medical Payment
Cardholder Billing Information
First/Last Name
Street Address 1
Street Address 2
City/State/Postal Code City/Province/Postal Code City/Province/Postal Code
Country
Phone Number  (nnn-nnn-nnnn)
Email Address For Email confirmation
 
 

Patient payments are applied to oldest balances first.

For help with billing questions, call (617) 258-5336. Hours M-F 8:30am 3:30 pm

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