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Make Payment
1
Patient
Info
2
Receipt
Patient
Account num.
First name
Last name
Phone
Email address (To email you a receipt. This is optional. And we respect your privacy.)
Payment
Payment amount
Invoice number(s) (optional)
If you are unable to pay the full amount due, make a partial payment.
Then, contact Spring Manor at tel: (847) 555-1234. Let us know when to expect the remaining payment.
Payment method
Card num
First name
Last name
Expiration
Billing ZIP
Credit card
CVC
eCheck (ACH)
Account type
Checking
Routing number
Bank account number
Savings
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