Autoimmune Brain Panel™

Online Bill Pay

Thank you for utilizing our Online Bill Pay to quickly and conveniently pay your Moleculera Biosciences invoice! Complete the form below to pay statement balances.

You will need the account number from your bill to begin the online payment process. If you have more than one bill from Moleculera Biosciences, each payment must be entered as a separate transaction.

This form is NOT for making a deposit payment. Pay your deposit by clicking the button below.

Please contact our billing department at 405-239-5260 or email: billing@moleculera.com if you need help.

Autoimmune Brain Panel™

Online Bill Payment

Patient Information
Patient Name*
Patient date of birth*
MM slash DD slash YYYY
Patient Account #*
Confirm Patient Account #*
If you need assistance, please contact our billing department at 405-239-5260 or email us at billing@moleculera.com.
Email Address*
Enter Email Confirm Email
A receipt for your payment will be sent to the email address you provide above.
Payment Information
Billing First Name*
Billing Last Name*
Amount to be charged*
Credit Card Zip Code*
Credit Card*
Total Payment
$0.00

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Autoimmune Brain Panel™

Online Bill Pay

Autoimmune Brain Panel™

Online Bill Payment

Patient Information

Payment Information