Pay Your MyAlly Health Bill Online

Pay Your MyAlly Health Bill Online

MyAlly Health | 4700 S Washington Street, Suite C | Grand Forks, ND 58201 | 701-757-ALLY.
Patient Name*

First NameLast Name
Patient Account Number
(If Available)
Patient Date of Birth*

MonthDayYear
Date
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Preferred Method of Contact*
*Please keep in mind that electronic communications may not be secure. Although it is unlikely and we do our best to keep your information secure, there is a possibility that it can be intercepted.
Newsletter

I would like to receive informational emails from MyAlly Health.
Payment Amount*
Bill Payment
Donation to MyAlly Health
Valley Health is able to keep costs low through contributions from our patients.
Calculation

Total Amount To Be Paid*

USDPayment Amount + Donation to MyAlly Health.

* If you have any billing questions, please contact Kerry at 701.757. ALLY (2559)
Credit Card Authorization*

I authorize MyAlly Health to charge the amount listed to the credit card above.
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