Filling Form on pay.gov

Hello Support!
I need to pay a co-pay to the VA Health Care System
I login at this site, using 1Password successfully:
https://www.pay.gov/public/home

On the resulting page I select (Click on)
Make a VA Medical Care Co-payment
Which opens this page:
https://www.pay.gov/public/form/start/25987221
This page is covered with eleven data entry fields which are ALWAYS the same plus an amount of payment (which may vary). HOW can I get 1Password to save this repeating data and auto-fill on my next visit?

This link is a preview of all of the fields which must be populated.
https://www.pay.gov/public/form/preview/pdf/101

You may need to communicate with pay.gov about this.
It is totally inconvenient the way the pay.gov site requires ALL of this data over and over.
Thanks for your help.
Ronald Breen

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