Patient Notebook

ProHealth (Peachtree City, GA)

PO Box 6890

Evansville, IN 47719

Phone: (866) 279 - 5049

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Error Summary

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1. Payment on Account

First Name *

M.I.

Last Name *

Patient Account Number *

Email Address

A receipt will be sent to this email address.

2. Payment Amount

Amount

Please be advised this amount will be paid to ProHealth for Therapy Services.

3. Payment Method

Credit/Debit Card

Bank Account

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Card Number *

Expiration Date *

Security Code *

Zip Code *

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