St. Louis Urgent Cares
PAYING AN OUTSTANDING BALANCE ON YOUR ACCOUNT
This online form is for those who wish to pay an outstanding balance on their urgent care account at any of the following locations:
DOWNTOWN URGENT CARE
NORTH CITY URGENT CARE
CREVE COEUR URGENT CARE
DOWNTOWN MEDICAL (Internal Medicine at STLPrimaryCare.com)
CONTACTADOC (Telemedicine at ContactADoc.com)
Please provide your personal information in this section.
Name of the person completing this form.
Are you paying for yourself today or for someone else?
For myself. I am the patient.
For someone else
At what facility was the patient seen?
Downtown Urgent Care
Creve Coeur Urgent Care
North City Urgent Care
ContactADoc Telemedicine (phone/text/video conference)
I really can't remember
Name of patient
Personal Direct Phone Number (the best number for us to contact you)
What is your understanding of how much you presently owe on your bill.
How much of your bill you would like to pay today:
This is the amount you will be paying online today.
ANY COMMENTS YOU MAY WISH TO ADD:
END OF FORM
Your payment information has been automatically copied to email@example.com so that your account will be credited automatically. Please use that email address if you wish to contact us.
Do Not Fill This Out