Patient Notebook

Community Ambulance

242 Holt Ave

Macon, GA 31201

Phone: (877) 455 - 7170

Fax: (877) 455 - 7182

Website: www.ourcommunityambulance.org

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Error Summary

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1. Patient Information

First Name *

M.I.

Last Name *

Patient Account Number *

Patient Date of Birth *

Email Address

A receipt will be sent to this email address.

2. Payment Amount

Amount

3. Payment Method

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Bank Account

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Card Number *

Expiration Date *

Security Code *

Zip Code *

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P (877) 455 - 7170

F (877) 455 - 7182

W www.ourcommunityambulance.org

242 Holt Ave

Macon, GA 31201