Copay
Patient Name / Date of Birth
Date of Appointment
The Glaucoma Institute, PC
10 Plum Street, 6th Floor, Suite 600
New Brunswick, New Jersey 08901
Office: 732-546-3910   myglaucoma@theglaucomainstitute.net    Fax: 480-287-9735
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Pay Copay

To pay your COPAY by CREDIT CARD:
1. Select copay amount
2. Enter patient name and date of birth
3. Enter appointment date
4. Click the "PAY NOW" button.
5. Click "continue" (on lower left side)

Your Credit Card shall be processed through PAYPAL. Thank you.
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