Bill Pay - CLINICA family health

Step 1 of 2 - Patient Information

Clinica Account Number*
Payment Amount*
Patient Name*
Patient First Name Patient Last Name
Patient Date of Birth*

Cardholder Name*
Cardholder First Name Cardholder Last Name
Cardholder Address*
Street Address Address Line 2 City State ZIP Code
Cardholder Email*
Cardholder Phone*
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Memo
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Comments
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The latest COVID-19 surge and the Marshall Fire are impacting Clinica’s staff. Many employees are out of the office due to illness. While we are offering all of our services, you might experience longer hold times, disruptions in pharmacy hours or some appointment cancellations. We apologize for any inconvenience and appreciate your understanding.