Clinica Home Page

Quality Community Health Care

(303) 650-4460


Online Patient Bill Payment

 

To pay your Clinica bill please complete the following information.
Card Type  
Card Number:
Card Expiration Date: mmyy
Clinica Account Number
Payment Amount
Patient First Name:
Patient Middle Name (or Initial):
Patient Last Name:
Patient Date of Birth:
The name below must match the name on your credit card.
First Name:
Middle Name (or Initial):
Last Name:
Phone Number
Email Address:
Address:
City:
State:
Zip Code:
Comments:
For Security Please Type Image Characters:

Refund Policy
Privacy Policy



Web Site Created by Clinica Development and Information Technology Department.
Published by Clinica Family Health Services.
 
Copyright 2008-2009 Clinica Family Health Services. All rights reserved.