Copper Ridge Surgery Center
* Account Number:
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The account number may not contain a credit card number.
* Date of Birth (mm/yy):
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The date of birth may not contain a credit card number.
* Patient Name:
The patient name is required.
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The patient name may not contain a credit card number.
* Payment Amount:
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Technical Support
If you need technical support for this online payment processing application, please send an email to
info@surgerytc.com
.