Language
English (US)
Care Credit payments can be made by clicking
here.
Chart Number
Found in the upper right corner of your statement. (Ex: DT8965K)
Patient Name
*
First Name
Last Name
Patient Date of Birth
*
-
Month
-
Day
Year
Date
Patient Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Patient Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Payment information
*
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Payment Details
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