PM PEDIATRICS • Care When You Need Us

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Important Notice: As of August 18, 2010 we are no longer accepting any payments for PM Pediatrics of Rockland, as we are no longer affiliated with them. Please contact them directly at (845) 357-5437 for payment instructions. Thank you.

Billing Information
(fields with asterisk (*) are required)

* Patient First Name:
* Patient Last Name:
* PM Pediatrics Account Number:
* Address:
Address 2:
* City:
* State:
* Zip Code:
Phone Number:
* Email Address:

Payment Information
(as it appears on the credit card)

* First Name:
* Last Name:
* Card Type:
* Card Number:
* Expiration Date:
* Security Code:
* Payment Amount:	Example (100.00)