Attention: Since we are a nonprofit, we strongly encourage consumers to send payment by check or cash, as card payments incur a fee for us and reduce the amount we receive. If you’d like to do this, quit this form and mail/drop off your invoice + payment to/at the address below:

Clarion Forest VNA
Attn: Payment
271 Perkins Rd
Clarion, PA 16214

NOTICE: Not all HSA cards are accepted through PayPal, so if your HSA card is being rejected then you’ll need to either pay out of pocket and request reimbursement from your HSA account OR contact your HSA support and have them write a check to us, using the address above.

    ๐—ก๐—ฎ๐—บ๐—ฒ

    ๐—˜๐—บ๐—ฎ๐—ถ๐—น

    For receiving a payment receipt.

    ๐—ฃ๐—ต๐—ผ๐—ป๐—ฒ #

    In case we need to contact you.

    ๐—ฃ๐—ฟ๐—ผ๐—ด๐—ฟ๐—ฎ๐—บ

    Home Health: General Nursing, Therapy, etc
    Hospice: End-of-Life Nursing, Support, Therapy, etc
    Adult Day Care: The Adult Daily Living Center in Shippenville (affiliate)
    Extended Care: Homecare services provided by VNA Extended Care Services (affiliate)

    ๐—”๐—ฐ๐—ฐ๐—ผ๐˜‚๐—ป๐˜ #

    This should be printed on your invoice.

    ๐—”๐—บ๐—ผ๐˜‚๐—ป๐˜

    If you have any questions or issues regarding this form, please contact us via email at support@cfvna.org or via phone at 814-297-8400.

    * We do not collect email addresses, payment information, or opt you into any subscriptions. We require an email for a payment receipt and/or if we need to contact you regarding the payment. If you make a payment over the phone, we securely dispose of payment information immediately after processing payment.

    * Your connection to this form is encrypted with SSL and the information you enter is protected.