Clinical Services Payment Form - YOUTH & FAMILY SERVICES OF HADDAM-KILLINGWORTH, INC.

Pay for Clinical Services

Please use the form below to pay all or a portion of your current HKYFS Clinical Services bill. You will receive an email from HKYFS as well as our payment processor, Stripe, once the payment has been successfully processed. If you do not receive an email receipt, please contact our office at officemanager@hkyfs.org.

Patient's Name(Required)

Cardholder's Name(Required)

Address

Street Address City State / Province / Region ZIP / Postal Code

Cardholder's Email Address(Required)

HKYFS Account Number(Required)

Payment Amount(Required)

Total Due

This field is for validation purposes and should be left unchanged.

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Pay for Clinical Services

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Help build a better future.

1. Support us with a monthly donation.

2. Join our community.

Pay for Clinical Services

JOIN US

Help build a better future.

1. Support us with a monthly donation.

2. Join our community.

Honoree Details

Notification Details