Drug Screen (UA) Payment

Pay for UA

If you are completing a UA/drug screen, please fill out the form below for payment.

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UA Fee (Required)

$16.50

Is this UA for Wadsworth or Cleveland (Required)

First Name (Required)

Last Name (Required)

Credit Card Information

Cardholder Name (Required)

Credit Card # (Required)

Visa MasterCard American Express Discover

Expiration Date (Required)

Security Code (Required)

Visa®, MasterCard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

Billing Zip Code (Required)

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

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Huntington Bank
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ACA Accreditation
PREA

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