WASHINGTON URGENT CARE
7701 26 MILE ROAD
WASHINGTON TWP, MI 48094
(586) 935-4000

Order Info
Thank you for Choosing My Health Urgent Care!
Account Information
* Indicates a Required Field
Payment Amount  *
Card Number  *
CVV2  *
Expiration Date  *
/
Zip  *

Billing Information
Contact Name *
Address  *
Address 2
City  *
State  *
Zip  *
Cell Phone #
Telephone #
Email
Remittance Advice 1 *Patients Name *

Remittance Advice 2Patients Name *

Remittance Advice 3Date of Birth *

Customer NumberAccount Number

Account Number

Date of Birth *



Error Advice


Transaction: For your protection, this website is secured with the highest level of SSL Certificate encryption.