Patient eServices

If a patient payment results in an overpayment, or was made in error, Holy Cross Medical Group reserves the right to refund the patient via direct payment to the patient’s credit card, or via a check addressed to the patient.

Account Details (This information appears on your statement.) Statement Date

Account Number

Amount Due $

Payment Amount $
Addressee Name

Credit / Debit Card Information Pay Amount $
Card Type
Name on Card
Card Number

1111222233334444

Expiration Date

Verification Code

What is this?

Credit Card Statement information:

Telephone
Address
City
State
Zip

Payment Terms Agreement I accept payment terms

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Receipt Email Address

Your transaction receipt will be sent to the email address provided.

Captcha Verification

Code

(Enter the code from the image below)

BotDetect ASP Classic CAPTCHA Component

(Please click the Process Payment button only ONCE.)

Verification Code

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The Credit Card Association supports the Card Verification 2 Security Code (Vcode), a fraud mitigation feature.

Visa, MasterCard and Discover display a 3-digit code on the back of the card in the signature block at the end of the regular account number.

American Express displays a 4-digit code on the front of the card.

The Vcode value helps validate that ...
The customer has the actual card in his/her possession, and the card account is legitimate.

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My Health Patient Portal

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You may enter additional account numbers and amounts if paying more than one account.
	Account Number	Payment Amount ($)
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Patient eServices

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