Please use this page to apply a payment to patient’s account at Providence Care.

To ensure that your payment is applied to the proper patient’s account, we need to collect the patient’s full name, the patient’s date of birth, and a contact phone number for the person responsible for the payment, in case there’s a question.

The phone number does not have to be for the patient, but instead, should be for the best person to reach about the payment only.

Thank you!

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Cardholder First Name*: Cardholder Last Name: Email*: Phone*: Amount*: Invoice Number: Patient's Name*: Patient's Date of Birth*: