Bill Payment

Patient Account Information
First Name*
Last Name*
Patient Number*
Cardholder Information
Name on Card*
Address*
Street Address Line 1
 
Street Address Line 2
 
City
State
Zip
Phone*
Email Address*
Additional Comments/Questions
Payment Information
Charge Amount*
Card Type*
Card Number*
Security Code*
Expiration Date*
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Saban Community Clinic relies heavily on the support of our community to continue to give back to those in need. Learn how you can help support us in our efforts.