×
Close
ACCOUNT # SAMPLE
™
Clinic Service Corporate Office
3464 South Willow St.
Denver, CO 80231
303-755-2900
info@clinicservice.com
www.clinicservice.com
SEARCH MY ACCOUNT
Pay My Doc online is fast, easy and secure.
Account Number:
What is this?
Last Name:
1.
Payment Types:
Card #:
Expiration date:
/
CVC:
2.
Billing address is my Mailing address
Holder Name:
Billing Address:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
N.Hampshire
N.Jersey
N.Mexico
New York
N.Carolina
N.Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
S.Carolina
S.Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Telephone:
-
-
Email:
Email My Statements
3.
Last Statement:
Insurance:
Patient:
Pay:
Message:
Send Receipt