Make a Payment | Center for Effective Living, serving West Side Cleveland, Ohio

Patient Name *

Email *

Parent/Guardian Name

Patient's Date of Birth *

Payment Amount *

($10 minimum. Only numbers and decimals, do not include $)

Make this a recurring monthly payment? *

No

Yes

(You will need to contact us to have the recurring payment cancelled when you are finished paying.)

Name on Card *

Credit Card *

Type of Card *