lima.patientwallet.com
Open in
urlscan Pro
54.192.51.69
Public Scan
URL:
https://lima.patientwallet.com/
Submission: On March 22 via api from US — Scanned from US
Submission: On March 22 via api from US — Scanned from US
Form analysis 21 forms found in the DOM
Name: forms.verifyAcctForm —
<form name="forms.verifyAcctForm" novalidate="">
<h2 class="modal-header h-style-2"></h2>
<h3 class="modal-subheader h-style-4"></h3>
<div class="interaction-feedback" style="display: none;"></div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><input type="text" pastdate="" required="" maxlength="10" autocomplete="off" class="fs-block" name="birthdate" placeholder="Date of Birth (MM/DD/YYYY)"></div>
<div class="input-area-feedback">
<div style="display: none;"><!----></div>
</div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><input type="text" name="SSN" required="" class="fs-block" minlength="4" maxlength="4" inputmode="decimal" placeholder="Last Four Digits of Social Security Number" autocomplete="off"></div>
<div class="input-area-feedback">
<div class="vue-messages"><!----></div>
</div>
</div>
<div class="SSN-help-text explanation-text" style="display: none;"><b>Note:</b> If you're adding accounts for an infant, use the guarantor's SSN</div><button class="button-primary button-callout submit-button"></button>
</form>Name: forms.changePasswordForm —
<form name="forms.changePasswordForm" novalidate=""><!---->
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-lock mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="currentPassword"
type="password" maxlength="255" id="change-current-pass" placeholder="Current Password" class="fs-block input-with-icon" tabindex="1"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="input-area-wrapper login-password-input-area">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-lock mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="password"
type="password" maxlength="255" id="new-pass" placeholder="New Password" class="fs-block input-with-icon" tabindex="2"></div>
<div class="input-area-rules">
<ul>
<li class="rule-met"><span
class="rule-met-icon"><i class="mdi-checkbox-marked-circle mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 8
characters</li>
<li class="rule-met"><span
class="rule-met-icon"><i class="mdi-checkbox-marked-circle mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 1
uppercase letter</li>
<li class="rule-met"><span
class="rule-met-icon"><i class="mdi-checkbox-marked-circle mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 1 number
</li>
</ul>
</div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-lock mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="confirmPassword"
type="password" id="confirm-new-pass" match="fields.newPassword" placeholder="Confirm Password" class="fs-block input-with-icon" tabindex="3"></div>
<div class="input-area-feedback"><!----></div>
</div>
</form>Name: forms.confirmEmailForm —
<form name="forms.confirmEmailForm" novalidate="">
<h2 class="modal-header h-style-2">Verify Email Address</h2>
<div class="input-area-wrapper">
<div data-v-993a36f4="" class="input-area-field-wrapper"><span data-v-993a36f4=""
class=""><i data-v-993a36f4="" class="mdi-email mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input
data-v-993a36f4="" required="" placeholder="Email Address" name="email" type="email" data-testid="settings-contact-form-email" class="fs-block input-with-icon details-email"></div>
<div class="input-area-feedback">
<div class="vue-messages"><!----><!----><!----></div>
</div><span class="explanation">Is the email address listed correct? If not, please correct it above prior to clicking the "Send Email" button to update your account.</span>
</div>
</form>Name: confirmPasswordForm —
<form name="confirmPasswordForm" novalidate="">
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-lock mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="password"
type="password" maxlength="255" id="confirm-current-pass" class="input-with-icon fs-block" placeholder="Password"></div>
<div class="input-area-feedback">
<div class="vue-messages"><!----></div>
</div>
</div>
</form>Name: forms.confirmPhoneForm —
<form name="forms.confirmPhoneForm" novalidate="">
<h2 class="modal-header h-style-2">Complete Account Registration</h2>
<h3 class="modal-subheader h-style-4">Please verify your mobile phone number.</h3>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-phone mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input name="phoneNumber" type="text"
required="" placeholder="Mobile Phone" class="input-with-icon fs-block" tabindex="0" maxlength="12"></div>
<div class="input-area-feedback"><!----></div><span>
<div>You will receive a text message with a unique code to verify your mobile phone number.</div>
</span>
</div>
</form>Name: forms.verifyCodeForm —
<form name="forms.verifyCodeForm" novalidate="" style="display: none;">
<h2 class="modal-header h-style-2">Complete Account Registration</h2>
<h3 class="modal-subheader h-style-4">Please enter the code we sent to your mobile device via SMS.</h3>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><input name="code" type="text" required="" placeholder="Verification Code" tabindex="0" maxlength="6" autocomplete="off"></div>
<div class="input-area-feedback"><!----></div>
</div>
</form>Name: forms.scEmailForm —
<form name="forms.scEmailForm" novalidate=""><!---->
<div class="modal-text">Please enter your email address:</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-email mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="email"
type="email" autocapitalize="off" autocorrect="off" autosuggest="off" id="contact-bill-email" placeholder="Email Address" tabindex="1" maxlength="255" class="fs-block input-with-icon"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="modal-text">Please enter your bill details:</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><svg aria-label="bill-secure-code-icon" version="1.1" focusable="false" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" x="0px" y="0px" viewBox="0 0 36.5 36.5"
enable-background="new 0 0 36.5 36.5" xml:space="preserve" class="v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);">
<circle fill="#08A650" cx="18.2" cy="18.3" r="18"></circle>
<g>
<path fill="#FFFFFF" d="M23.5,17.2l-11.7,0c0,1.8-0.1,4.1-0.2,6c-0.2,4.4,3.5,6.7,7.1,6.5c4.2-0.2,5-4.7,5-4.7S23.5,20.6,23.5,17.2
"></path>
<path fill="#FFFFFF" d="M17.9,11.3l-5.1-0.1c-0.9,0.3-1,2-1,2s0,1.1,0,2.8l6.2,0L17.9,11.3z"></path>
<path fill="#FFFFFF" d="M23.5,16c0-1,0-1.8,0.1-2.2c0.2-1.9-1.4-2.4-1.4-2.4l-3,0c0,1.7,0.1,4,0.1,4.7L23.5,16z"></path>
<path fill="none" stroke="#FFFFFF" stroke-width="1.4236" stroke-miterlimit="10" d="M17.8,10.7C17.6,6,23.1,6,23.1,6"></path>
</g>
</svg><input type="text" required="" id="contact-bill-scode" tabindex="2" name="scode" autocomplete="off" placeholder="SecureHealthCode on Bill" class="fs-block input-with-icon" maxlength="11"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="input-area-wrapper" autocomplete="off">
<div class="input-area-field-wrapper"><svg aria-label="bill-amount-icon" version="1.1" focusable="false" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" x="0px" y="0px" viewBox="0 0 36.5 20.5"
enable-background="new 0 0 36.5 20.5" xml:space="preserve" class="v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);">
<path fill="#10356B" d="M0.6,20.1c-0.2,0.1-0.3-0.1-0.3-0.2V7.5c0-0.1,0.1-0.2,0.2-0.2c1.7-0.7,15.9-6.3,17.7-7c0.1,0,0.2,0,0.3,0
c1.7,0.7,16,6.3,17.7,7c0.1,0,0.2,0.1,0.2,0.2v12.4c0,0.2-0.2,0.3-0.3,0.2l-17.5-6.8c-0.1,0-0.2,0-0.4,0L0.6,20.1z"></path>
</svg><input tabindex="3" type="text" id="contact-bill-amount" name="billAmount" required="" maxlength="20" placeholder="Total Balance Due on Bill" class="fs-block input-with-icon"></div>
<div class="input-area-feedback"><!----></div>
</div><button class="button-primary submit-verify" tabindex="4">Verify</button><button type="button" tabindex="5" class="button">Back</button>
</form>Name: forms.createForm —
<form name="forms.createForm" novalidate="">
<h2 class="modal-header">Almost there...</h2>
<div class="modal-text">Please create a password:</div>
<div class="input-area-wrapper login-password-input-area">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-lock mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="password"
type="password" valid-password="" id="contact-register-pass" maxlength="255" placeholder="Password" tabindex="4" class="fs-block input-with-icon"></div>
<div class="input-area-rules">
<ul>
<li class=""><span class="rule-met-icon"><i class="mdi-circle mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 8
characters</li>
<li class=""><span class="rule-met-icon"><i class="mdi-circle mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 1
uppercase letter</li>
<li class=""><span class="rule-met-icon"><i class="mdi-circle mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 1 number
</li>
</ul>
</div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-lock mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="confirmPassword"
type="password" id="contact-register-con-pass" placeholder="Confirm Password" tabindex="5" class="fs-block input-with-icon"></div>
<div class="input-area-feedback">
<div class="vue-messages">
<div class="vue-message">Please complete this field to continue.</div>
</div>
</div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper no-initial-border"><input required="" name="tou" id="contact-tou" type="checkbox" tabindex="6"><label for="contact-tou" class="create-account-terms">I agree to the
<a href="https://www.waystar.com/patientco-terms-of-use/" target="_blank">Terms of Use</a></label></div>
<div class="input-area-feedback">
<div class="vue-messages">
<div class="vue-message">For legal reasons, we require all users to accept our Terms of Use.</div>
</div>
</div>
</div><button tabindex="7" class="button button-primary">Submit</button><button tabindex="8" type="button" class="button">Back</button>
</form>Name: forms.loginForm —
<form name="forms.loginForm" novalidate="">
<h2 class="modal-header">Almost there...</h2><!---->
<div class="modal-text">Please log in to your account:</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-email mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input tabindex="1" name="email"
type="email" required="" autocapitalize="off" maxlength="255" placeholder="Email Address" id="contact-login-email" class="fs-block input-with-icon"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-lock mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input id="contact-login-pass" tabindex="2"
name="password" type="password" required="" placeholder="Password" class="fs-block input-with-icon"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="login-forgot-password-link"><span tabindex="3" class="link-text">Forgot Your Password?</span></div><button tabindex="4" class="button button-primary">Submit</button><button tabindex="5" type="button" class="button">Back</button>
</form>Name: forms.contactForm —
<form name="forms.contactForm" novalidate="">
<div class="split-input-areas-container">
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-account mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="firstName"
type="text" id="contact-zendesk-first" placeholder="First Name" tabindex="1" class="fs-block input-with-icon"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-account mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="lastName"
type="text" id="contact-zendesk-last" placeholder="Last Name" tabindex="2" class="fs-block input-with-icon"></div>
<div class="input-area-feedback"><!----></div>
</div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-email mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="email"
type="email" autocapitalize="off" autocorrect="off" autosuggest="off" id="contact-zendesk-email" placeholder="Email Address" tabindex="3" maxlength="255" class="fs-block input-with-icon"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper no-initial-border"><textarea required="" maxlength="5000" name="message" placeholder="Start typing your message..." tabindex="4" class="fs-block"></textarea></div>
<div class="input-area-feedback"><!----></div>
</div>
<p class="info">For your security, please exclude personal health information.</p>
<div class="form-error"><!----></div><button class="button-primary" tabindex="5">Send Message</button><button tabindex="6" type="button" class="button">Back</button>
</form>Name: forms.feedbackForm —
<form name="forms.feedbackForm" class="form-clean" novalidate="">
<div class="comment-prompt"></div><!---->
<div class="input-area-wrapper">
<div class="input-area-field-wrapper no-initial-border inline-input-type"><textarea placeholder="Start typing feedback..." maxlength="5000" class="fs-block"></textarea></div>
</div><button class="button-primary send-feedback" id="submit-feedback">Send Feedback</button>
</form>Name: forms.createForm —
<form name="forms.createForm" novalidate="">
<div class="split-input-areas-container">
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-account mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="firstName"
type="text" id="register-first" class="fs-block input-with-icon" placeholder="First Name" tabindex="1"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-account mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="lastName"
type="text" id="register-last" class="fs-block input-with-icon" placeholder="Last Name" tabindex="2"></div>
<div class="input-area-feedback"><!----></div>
</div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-email mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="email"
type="email" class="fs-block input-with-icon" autocapitalize="off" autocorrect="off" autosuggest="off" id="register-email" placeholder="Email Address" tabindex="3" maxlength="255"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-phone mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input name="phone" type="text"
id="create-phone" phone-number="" sms-eligible="" class="fs-block input-with-icon" placeholder="Mobile Phone" tabindex="4" maxlength="12"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="input-area-wrapper login-password-input-area">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-lock mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="password"
type="password" id="register-pass" maxlength="255" class="fs-block input-with-icon" placeholder="Password" tabindex="5"></div>
<div class="input-area-rules register">
<ul>
<li class=""><span class="rule-met-icon"><i class="mdi-close mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 8
characters</li>
<li class=""><span class="rule-met-icon"><i class="mdi-close mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 1
uppercase letter</li>
<li class=""><span class="rule-met-icon"><i class="mdi-close mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 1 number
</li>
</ul>
</div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span class=""></span><input required="" name="confirmPassword" type="password" id="register-con-pass" class="fs-block input-with-icon" placeholder="Confirm Password" tabindex="6"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="register-checkboxes">
<div class="input-area-wrapper">
<div class="input-area-field-wrapper no-initial-border inline-input-type"><input id="receivesSms" name="receivesSms" type="checkbox" tabindex="7"><label for="receivesSms" class="create-account-terms">Text me new bills & reminders</label>
</div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper no-initial-border inline-input-type"><input required="" id="tou" name="tou" type="checkbox" tabindex="8"><label for="tou" class="create-account-terms">I agree to the
<a href="https://www.waystar.com/patientco-terms-of-use/" target="_blank">Terms of Use</a></label></div>
<div class="input-area-feedback"><!----></div>
</div>
</div><button class="button button-primary register-button" tabindex="8">Create Account</button><!----><!---->
</form>Name: forms.loginForm —
<form name="forms.loginForm" novalidate=""><!---->
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-email mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input class="fs-block input-with-icon"
name="email" type="email" required="" id="login-email" autocapitalize="off" maxlength="255" placeholder="Email Address"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-lock mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input class="fs-block input-with-icon"
name="password" type="password" required="" id="login-pass" placeholder="Password"></div>
<div class="input-area-feedback"><!----></div>
</div><button class="button button-primary">Log In</button><button class="button button-secondary forgot-password">Forgot Your Password?</button>
</form>Name: forms.forgotForm —
<form name="forms.forgotForm" novalidate="">
<div class="input-area-wrapper forgot-email-input">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-email mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input class="fs-block input-with-icon"
name="email" type="email" required="" maxlength="255" id="forgot-email" autocapitalize="off" ng-model-options="{ updateOn: 'blur submit' }" placeholder="Email Address"></div>
<div class="input-area-feedback"><!----></div>
</div><button class="button button-primary">Next</button>
</form>Name: forms.methodForm —
<form name="forms.methodForm" novalidate="">
<div class="contact-method"><button class="button button-primary button-block u-truncate fs-block forgot-password-email" style="display: none;">Email me (null)</button><button
class="button button-primary button-block fs-block forgot-password-phone" style="display: none;">Text me (null)</button></div>
</form>Name: forms.verifyForm —
<form name="forms.verifyForm" novalidate="">
<div class="input-area-wrapper">
<div class="input-area-field-wrapper verification-code"><input name="code" type="text" all-numeric="" required="" placeholder="Verification Code" tabindex="0" ng-model-options="{updateOn: 'default blur submit'}" maxlength="6" autocomplete="off">
</div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="modal-actions"><button type="button" class="button button-secondary">I didn't receive a code</button><button class="button button-primary">Next</button></div>
</form>Name: forms.resetPasswordForm —
<form name="forms.resetPasswordForm" novalidate=""><!---->
<div class="input-area-wrapper login-password-input-area">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-lock mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="password"
type="password" valid-password="" id="reset-pass" maxlength="255" class="fs-block input-with-icon" placeholder="New Password" tabindex="2"></div>
<div class="input-area-rules password-reset">
<ul>
<li class=""><span class="rule-met-icon"><i class="mdi-close mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 8
characters</li>
<li class=""><span class="rule-met-icon"><i class="mdi-close mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 1
uppercase letter</li>
<li class=""><span class="rule-met-icon"><i class="mdi-close mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 1 number
</li>
</ul>
</div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-lock mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input required="" name="confirmPassword"
type="password" id="reset-con-pass" match="resetPassword.password" valid-password="" class="fs-block input-with-icon" placeholder="Confirm Password" tabindex="3"></div>
<div class="input-area-feedback"><!----></div>
</div><button class="button button-primary" tabindex="4">Reset Password</button>
</form>Name: forms.myChartForm —
<form name="forms.myChartForm" novalidate="">
<h2 class="modal-header h-style-2"></h2>
<div class="modal-text">The PatientWallet is where you'll be able to access all of your bills and make payments.<br><br>Let's check to see if you already have an account.</div>
<div class="input-area-wrapper solo-input">
<div class="input-area-field-wrapper"><input name="checkEmail" type="email" class="fs-block" placeholder="Enter your email address"></div>
<div class="input-area-feedback"><!----><!----></div>
</div><button id="check-for-patient-wallet-button" class="button button-primary" tabindex="8" type="submit">Search</button>
</form><form><!---->
<h2 class="modal-header h-style-2">Set Up Your PatientWallet</h2><svg xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:cc="http://creativecommons.org/ns#" xmlns:rdf="http://www.w3.org/1999/02/22-rdf-syntax-ns#"
xmlns:svg="http://www.w3.org/2000/svg" xmlns="http://www.w3.org/2000/svg" xmlns:sodipodi="http://sodipodi.sourceforge.net/DTD/sodipodi-0.dtd" xmlns:inkscape="http://www.inkscape.org/namespaces/inkscape" version="1.1" x="0px" y="0px"
viewBox="0 0 100 125" style="max-width: 100px; margin-bottom: -30px; fill: rgb(97, 97, 97);">
<g transform="translate(0,-952.36218)">
<path
d="m 6.0000002,973.36217 a 2.0002,2.0002 0 0 0 -2,2 l 0,54.00003 a 2.0002,2.0002 0 0 0 2,2 l 87.9999998,0 a 2.0002,2.0002 0 0 0 2,-2 l 0,-54.00003 a 2.0002,2.0002 0 0 0 -2,-2 l -87.9999998,0 z m 5.4687498,4 77.0625,0 L 50,1009.7684 11.46875,977.36217 z m -3.4687498,2.28125 25.9687498,21.84378 -25.9687498,23.375 0,-45.21878 z m 83.9999998,0 0,45.21878 -25.96875,-23.375 L 92,979.64342 z m -54.9375,24.43748 11.65625,9.8125 a 2.0002,2.0002 0 0 0 2.5625,0 l 11.65625,-9.8125 25.875,23.2813 -77.625,0 25.875,-23.2813 z"
fill-opacity="1" stroke="none" marker="none" visibility="visible" display="inline" overflow="visible" style="text-indent: 0px; text-transform: none; direction: ltr; baseline-shift: baseline; color: rgb(0, 0, 0);"></path>
</g>
</svg><br>
<div data-v-397744fc="" class="notification notification-inline failure" style="display: none;">
<div data-v-397744fc="" class="primary-icon-container u-center-vertical"><span data-v-397744fc=""
class="icon-wrap"><i data-v-397744fc="" class="mdi-information-variant-circle-outline mdi v-icon notranslate v-theme--light text-white base-icon vuetify" aria-hidden="true" style="font-size: 30px; height: 30px; width: 30px;"></i></span></div>
<div data-v-397744fc="" class="notification-content-container u-center-vertical">
<div data-v-397744fc="" class="notification-content">
<span><i class="mdi-close-circle mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> There was a problem sending that code.
Please try again.</div>
</div>
</div>
<div data-v-397744fc="" class="notification notification-inline success" style="display: none;">
<div data-v-397744fc="" class="primary-icon-container u-center-vertical"><span data-v-397744fc=""
class="icon-wrap"><i data-v-397744fc="" class="mdi-information-variant-circle-outline mdi v-icon notranslate v-theme--light text-white base-icon vuetify" aria-hidden="true" style="font-size: 30px; height: 30px; width: 30px;"></i></span></div>
<div data-v-397744fc="" class="notification-content-container u-center-vertical">
<div data-v-397744fc="" class="notification-content">
<span><i class="mdi-checkbox-marked-circle mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> Code has been sent.</div>
</div>
</div>
<div class="modal-text fs-block"></div><!---->
<div class="input-area-field-wrapper solo-input"><input name="emailVerificationCode" type="text" class="fs-block" required="" placeholder="Verification Code"><a class="inline">Resend</a></div>
<div id="terms-of-use-input" class="input-area-wrapper">
<div class="input-area-field-wrapper no-initial-border inline-input-type"><input id="acceptTerms" name="acceptTerms" type="checkbox" tabindex="8"><label for="acceptTerms" class="create-account-terms">I agree to the
<a href="https://www.waystar.com/patientco-terms-of-use/" target="_blank">Terms of Use</a></label></div>
<div class="input-area-feedback"><!----></div>
</div><button id="verify-email-button" class="button button-primary">Verify</button>
<div><a>Use a different email address</a></div>
</form>Name: finishRegistrationForm —
<form name="finishRegistrationForm" novalidate="">
<div class="split-input-areas-container">
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span class="">\
<i class="mdi-account mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input name="firstName" type="text"
id="finishRegistration-first" class="fs-block input-with-icon" placeholder="First Name" tabindex="1"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper">
<div><span class=""><i class="mdi-account mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span></div><input name="lastName"
type="text" id="finishRegistration-last" class="fs-block input-with-icon" placeholder="Last Name" tabindex="2">
</div>
<div class="input-area-feedback"><!----></div>
</div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span><i class="mdi-email mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input
name="email" type="email" class="fs-block input-with-icon" disabled="" autocapitalize="off" autocorrect="off" autosuggest="off" id="finishRegistration-email" placeholder="Email Address" tabindex="3" maxlength="255"></div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-phone mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input name="phone" type="text"
id="finishRegistration-phone" class="fs-block input-with-icon" placeholder="Mobile Phone" tabindex="4" maxlength="12"></div>
<div class="input-area-feedback">
<div class="vue-messages"><!----><!----></div>
</div>
</div>
<div class="input-area-wrapper login-password-input-area">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-lock mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input name="password" type="password"
id="finishRegistration-pass" maxlength="255" class="fs-block input-with-icon" placeholder="Password" tabindex="5"></div>
<div class="input-area-rules">
<ul>
<li class="min-char-rule"><span
class="rule-met-icon"><i class="mdi-checkbox-marked-circle mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 8
characters</li>
<li class="upper-case-rule"><span
class="rule-met-icon"><i class="mdi-checkbox-marked-circle mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 1
uppercase letter</li>
<li class="digit-rule"><span
class="rule-met-icon"><i class="mdi-checkbox-marked-circle mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span> 1 number
</li>
</ul>
</div>
</div>
<div class="input-area-wrapper">
<div class="input-area-field-wrapper"><span
class=""><i class="mdi-lock mdi v-icon notranslate v-theme--light v-icon--size-default base-icon vuetify" aria-hidden="true" style="color: rgb(0, 138, 62); caret-color: rgb(0, 138, 62);"></i></span><input name="confirmPassword"
type="password" id="finishRegistration-con-pass" match="" class="fs-block input-with-icon" placeholder="Confirm Password" tabindex="6"></div>
<div class="input-area-feedback"><!----></div>
</div>
<div class="register-checkboxes">
<div class="input-area-wrapper">
<div class="input-area-field-wrapper no-initial-border inline-input-type"><input id="finishRegistration-receivesSms" name="receivesSms" type="checkbox" tabindex="7"><label for="finishRegistration-receivesSms" class="create-account-terms">Text
me new bills & reminders</label></div>
</div>
</div><button class="button button-primary" tabindex="8">Save</button>
</form>Name: forms.verifyEmailCodeForm —
<form data-v-45e7d9cc="" name="forms.verifyEmailCodeForm" novalidate="">
<div data-v-45e7d9cc="" class="interaction-feedback vue-messages"><!----></div>
<div data-v-45e7d9cc="" class="input-area-wrapper">
<div data-v-45e7d9cc="" class="input-area-field-wrapper"><input data-v-45e7d9cc="" name="emailVerificationCode" class="email-verification-code" type="text" inputmode="decimal" required="" placeholder="Verification Code" tabindex="0"
maxlength="6"><a data-v-45e7d9cc="" class="inline resend-code">Resend</a></div>
<div data-v-45e7d9cc="" class="input-area-feedback">
<div data-v-45e7d9cc="" class="vue-messages">
<div data-v-45e7d9cc="" class="vue-message" style="display: none;">Please complete this field to continue.</div>
</div>
</div>
</div>
</form>Text Content
We're sorry but PatientWallet doesn't work properly without JavaScript enabled. Please enable it to continue. Patientco Logo PATIENTCO Patientco Enter the unique details from your bill. We cannot find a bill matching the SecureHealthCode and total balance you've entered. Please check to make sure your details are correct. You have attempted to find a bill too many times. For security reasons, your ability to search for bills has been disabled for a few minutes. Find Bill Need help? Cambiar a Español Log InContact Us Welcome to the PatientWallet®! We’ve partnered with your healthcare provider to give you the simplest, most secure payment experience possible. © 2024 About Privacy Terms WHO WOULD YOU LIKE TO VERIFY? Note: If you're adding accounts for an infant, use the guarantor's SSN BROWSER INFO * Browser: * Version: * User Agent: Loading IP Details... * IP: * Location: , , APPLICATION INFO * Root URL: https://www.gopatientco.com/ * Base URL: * API URL: /api * Backendless: false * Environment: production * Languages: [ "en", "es" ] * Pendo Enabled: false * Version: Copy to Clipboard CHANGE PASSWORD * 8 characters * 1 uppercase letter * 1 number Save Changes There was a problem sending that email. Please try again. VERIFY EMAIL ADDRESS Is the email address listed correct? If not, please correct it above prior to clicking the "Send Email" button to update your account. Send Email Submit There was a problem sending that code. Please try again. That code was invalid or expired. Please try again. COMPLETE ACCOUNT REGISTRATION PLEASE VERIFY YOUR MOBILE PHONE NUMBER. You will receive a text message with a unique code to verify your mobile phone number. COMPLETE ACCOUNT REGISTRATION PLEASE ENTER THE CODE WE SENT TO YOUR MOBILE DEVICE VIA SMS. By verifying your phone number, you agree to allow Patientco to send you periodic text messages on behalf of your provider for any account-related activity. Patientco may use an automated system to send you electronic communications including text, phone, or email. Patientco does not have a separate charge for this service; however, subject to the terms and conditions of your mobile carrier, message and data rates may apply. By providing your consent to participate in this program, you approve any such charges from your mobile carrier. You may opt out of this program at any time by emailing Patientco at support@patientco.com. Learn MoreI didn't receive a codeSend Code I NEED HELP WITH: Understanding my billI need an itemized billI lost my billLogging inReset my password I HAVE A QUESTION ABOUT: A charge on my billCreating a payment planA duplicate charge or billMissing paymentsUpdating InformationInsuranceRequesting an itemized billFinancial assistanceEstimateOtherBack LET'S GET YOU TO THE RIGHT PLACE. Please enter your email address: Please enter your bill details: VerifyBack ALMOST THERE... Please create a password: * 8 characters * 1 uppercase letter * 1 number Please complete this field to continue. I agree to the Terms of Use For legal reasons, we require all users to accept our Terms of Use. SubmitBack ALMOST THERE... Please log in to your account: Forgot Your Password? SubmitBack THANKS FOR REACHING OUT! WE'RE EXCITED TO HEAR FROM YOU. For your security, please exclude personal health information. Send MessageBack 0 1 2 3 4 5 6 7 8 9 10 Not at all likelyExtremely likely Send Feedback There was a problem sending that code. Please try again. That code was invalid or expired. Please try again. WELCOME TO YOUR PATIENTWALLET® Create AccountLog In * 8 characters * 1 uppercase letter * 1 number Text me new bills & reminders I agree to the Terms of Use Create Account Log InForgot Your Password? FORGOT YOUR PASSWORD? WE'VE GOT YOU COVERED. Next HOW WOULD YOU LIKE TO RESET YOUR PASSWORD? Email me (null)Text me (null) PLEASE ENTER YOUR VERIFICATION CODE. I didn't receive a codeNext CHECK YOUR EMAIL AND CLICK THE LINK. We just sent an email containing a password reset link to null. If you don't see it in your inbox, be sure to check your spam folder. Try Again CREATE YOUR NEW PASSWORD. * 8 characters * 1 uppercase letter * 1 number Reset Password WELCOME TO YOUR PATIENTWALLET® Log In with null The PatientWallet is where you'll be able to access all of your bills and make payments. Let's check to see if you already have an account. Search SET UP YOUR PATIENTWALLET There was a problem sending that code. Please try again. Code has been sent. Resend I agree to the Terms of Use Verify Use a different email address WELCOME BACK! It looks like you've accessed your PatientWallet before through MyChart. Please finish setting up your account by adding your phone number and a password. \ * 8 characters * 1 uppercase letter * 1 number Text me new bills & reminders Save WHICH BILL WOULD YOU LIKE TO PAY? Pay New Bill ENTER DETAILS FROM YOUR NEW BILL. We cannot find a bill matching the SecureHealthCode and total balance you've entered. Please check to make sure your details are correct. You have attempted to find a bill too many times. For security reasons, your ability to search for bills has been disabled for a few minutes. Find Bill Loading... NOTIFICATIONS No Notifications You are now being redirected to your PatientWallet® An error occurred while attempting to redirect you to your PatientWallet®. Please try again, and if you continue to have problems please contact your provider. UPDATES TO TERMS OF USE & PRIVACY POLICY We have updated our Terms of Use and Privacy Policy to make it easier for you to understand what information we collect and why. As a friendly reminder, Patientco will never share your information with third party marketers, and you can always update your Communication Preferences within your Settings. We encourage you to review our new Terms of Use and Privacy Policy. To accept the new Terms of Use and Privacy Policy, click "Accept" below. Accept VERIFY EMAIL We were unable to send the verification email. Please try again. Code has been sent. Explanation Resend Please complete this field to continue. Verify