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Avera Medical Group McGreevy Bill Pay
1910 West 69th Street
Sioux Falls,SD 57105
(605) 322-4900

STEP 1
Payment
       
STEP 2
Confirm
       
STEP 3
Receipt
Payment Type

           
Credit Card Bank Account

Patient
*Bold fields are required



Patient ID PatientMedicalRecordNumber First Name Last Name Birth Date PatientServiceBeginDate PatientServiceEndDate AdditionalInfo1 Additional Info 2 Additional Info 3 Additional Info 4 Additional Info 5 Additional Info 6 Amount
Add Row Total $0.00
Clinic Account Number (MG+10 digits)
Last Name
First Name  Middle :
  (MM/DD/YYYY)
Daytime Phone #  -  - 
Email Address
Address
City
State        Zip    -
Zip    -
Comments
Additional Information

Payment Information

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Card :
Card Holder Name
Card Type
Card Number   Exp Date   (MM/YY)
CVN   What is this?
Amount            Current Balance  
Save this card for future use
  Your credit card/bank account will not be charged
until all information is confirmed in the next step.