WHEN THE FORM OPENS, PLEASE REMEMBER TO ENTER THE NAME OF THE IDENTIFIED PATIENT IN THE APPROPRIATE BOX SO WE CAN ATTRIBUTE THE PAYMENT TO THE CORRECT ACCOUNT.

*Disclosure

CCG uses a third-party credit card processing company, Rectangle Health. When you click the pay button above, you will be directed to an external site managed by that processing company. CCG does not maintain or manage that site. CCG has a contract with this company to manage credit card transactions.

You can view Rectangle Health’s privacy policy here: Privacy Policy