Customer Vault - Patient Information

CooperGenomics securely processes and stores credit and debit card information through Rectangle Health's encrypted and secure payment processing Customer Vault lnterface. Rectangle Health's Customer Vault allows CooperGenomics to transmit its patients' payment information through a Transport Layer Security (TLS) 1.2 connection for storage in Rectangle Health's Level 1 PCI certified data facilities. Once the record has been securely transmitted, CooperGenomics can initiate transactions remotely without having to access your credit card information directly. This process is accomplished without CooperGenomics storing your credit card information in our system.

Vault authorization

You are providing your credit card information at the time you consent to CooperGenomics’ testing services. Your credit card information will be held securely until CooperGenomics begins to process your test(s). CooperGenomics will only be able to view your name, patient account number, and the last 4-digits of your credit card. Your credit card will be charged only after CooperGenomics has received your samples for testing.

I authorize CooperGenomics to charge my credit card my patient responsibility in accordance with the fees quoted in my CooperGenomics Welcome email, up to a maximum of $6,000, for the test(s) performed. If your patient responsibility exceeds the maximum authorized amount, CooperGenomics will require payment of the remaining balance before processing your tests and providing test results. This authorization will be valid for 1 year.

Charge authorization

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Patient Information

First Name

Please enter your first name

Last Name

Please enter your last name

Date of Birth

Please enter your date of birth in this format: mm/dd/yyyy

Customer Vault ID (Formerly known as Patient EPI)

Please enter a valid Customer Vault ID (from 6 to 8 characters)

Email Address

Please enter your Email address