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patientportal.advancedmd.com Open in urlscan Pro
54.244.105.171  Public Scan

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Submitted URL: https://advmd.co/P52X94xO
Effective URL: https://patientportal.advancedmd.com/132677/billing?token=NEpDSWlrSzVUa3FucXY3UlNTUXdKTVVTVTRPVUNyWmxrb3BFR2dIaCtOOXF0ZzZFTGRZaHF0bVY...
Submission: On January 20 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

<form _ngcontent-mfy-c169="" novalidate="" class="ng-untouched ng-pristine ng-valid">
  <div _ngcontent-mfy-c169="" class="col-xs-6 col-sm-3 col-md-3 payment-pay-now payment-cell">
    <div _ngcontent-mfy-c169="">
      <div _ngcontent-mfy-c169="" class="payment-title-container"><span _ngcontent-mfy-c169="" class="payment-title">Pay Now</span><span _ngcontent-mfy-c169="" tabindex="1"
          mattooltip="The Total Balance may include charges received since the last statement, in addition to payment plan balance. Statement Balances include charges from the current billing statement and might not contain the most recent charges and/or payments."
          mattooltipposition="below" class="mat-tooltip-trigger pay-now-info-tooltip" aria-describedby="cdk-describedby-message-0" cdk-describedby-host=""><em _ngcontent-mfy-c169=""
            class="amds-icon amds-icon-info-circle payment-pay-now-info-icon"></em></span><!----><!----><!----></div>
      <div _ngcontent-mfy-c169="" class="payment-radio-container"><mat-radio-button _ngcontent-mfy-c169="" name="payment-amount" class="mat-radio-button mat-radio-checked mat-accent" id="mat-radio-1"><label class="mat-radio-label"
            for="mat-radio-1-input"><span class="mat-radio-container"><span class="mat-radio-outer-circle"></span><span class="mat-radio-inner-circle"></span><input type="radio" class="mat-radio-input cdk-visually-hidden" id="mat-radio-1-input"
                tabindex="0" name="payment-amount"><span mat-ripple="" class="mat-ripple mat-radio-ripple mat-focus-indicator"><span class="mat-ripple-element mat-radio-persistent-ripple"></span></span></span><span
              class="mat-radio-label-content"><span style="display: none;">&nbsp;</span><span _ngcontent-mfy-c169="" class="payment-text">Total Balance:</span><span _ngcontent-mfy-c169=""
                class="payment-text payment-text-bold">$6.72</span></span></label></mat-radio-button></div>
      <div _ngcontent-mfy-c169="" class="payment-radio-container"><mat-radio-button _ngcontent-mfy-c169="" name="payment-amount" class="mat-radio-button mat-accent" id="mat-radio-2"><label class="mat-radio-label" for="mat-radio-2-input"><span
              class="mat-radio-container"><span class="mat-radio-outer-circle"></span><span class="mat-radio-inner-circle"></span><input type="radio" class="mat-radio-input cdk-visually-hidden" id="mat-radio-2-input" tabindex="0"
                name="payment-amount"><span mat-ripple="" class="mat-ripple mat-radio-ripple mat-focus-indicator"><span class="mat-ripple-element mat-radio-persistent-ripple"></span></span></span><span class="mat-radio-label-content"><span
                style="display: none;">&nbsp;</span><span _ngcontent-mfy-c169="" class="payment-text">Statement Balance:</span><span _ngcontent-mfy-c169="" class="payment-text payment-text-bold">$6.72</span></span></label></mat-radio-button></div>
      <!----><!----><!----><!---->
      <div _ngcontent-mfy-c169="" class="payment-radio-container"><mat-radio-button _ngcontent-mfy-c169="" name="payment-amount" class="mat-radio-button payment-custom-amount mat-accent" id="mat-radio-3"><label class="mat-radio-label"
            for="mat-radio-3-input"><span class="mat-radio-container"><span class="mat-radio-outer-circle"></span><span class="mat-radio-inner-circle"></span><input type="radio" class="mat-radio-input cdk-visually-hidden" id="mat-radio-3-input"
                tabindex="0" name="payment-amount"><span mat-ripple="" class="mat-ripple mat-radio-ripple mat-focus-indicator"><span class="mat-ripple-element mat-radio-persistent-ripple"></span></span></span><span
              class="mat-radio-label-content"><span style="display: none;">&nbsp;</span><input _ngcontent-mfy-c169="" type="tel" inputmode="decimal" formcontrolname="customAmountInput" maxlength="7" placeholder="Other Amount: $0.00"
                amdsportalbillingcurrencyinput="" class="payment-custom-ammount-input custom-input-empty ng-untouched ng-pristine ng-valid"></span></label></mat-radio-button></div><!---->
    </div>
  </div>
  <div _ngcontent-mfy-c169="" class="col-xs-6 col-sm-3 col-md-3 make-payment-section">
    <div _ngcontent-mfy-c169="" class="payment-submit"><button _ngcontent-mfy-c169="" type="button" class="payment-make-payment-button">Make Payment</button><!----></div><!---->
  </div>
</form>

Text Content

PAY MY BILL



EKINE, KINGSLEY
Pay My Bill
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EKINE, KINGSLEY
Please enter a payment amount between $5.00 and $6.72
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Patient
Insurance Bal.
Patient Bal.
Ekine, Kingsley
Insurance Balance:
$0.00
Patient Balance:
$6.72


Pay Now
 Total Balance:$6.72
 Statement Balance:$6.72
 
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 Address & Directions | Privacy Statement

 Address & Directions

Privacy Statement


The Total Balance may include charges received since the last statement, in
addition to payment plan balance. Statement Balances include charges from the
current billing statement and might not contain the most recent charges and/or
payments.