Online Patient Payment Center
Welcome to Bacon County Hospital Online Payment Center. You may pay your hospital bills here by credit card only.
For your convenience please fill out the payment form below. All information will be kept secure and confidential. For more information you may call our business office during working hours, Monday through Friday, 8:00 a.m. to 4:30 p.m..
You may make payments to Bacon County Hospital using your credit card information in the fields below. All payments are via secure server. Thank you for allowing us to serve you.
Name of Patient
Name of patient treated.
Account Number. (This number is located on your bill.)
Name of Payor
List the name as it appears on the credit card.
Address where your credit card statements are mailed.
City, State, Zip
Please provide area code and phone number as indicated (i.e, 000-000-0000)
Your E-Mail Address
Please provide an e-mail address.
Amount of Your Payment
Please specify how much you are paying. Please indicate dollars and cents.
Credit Card Number
Input the 16 digit number just as it appears on the credit card.
Credit Card Type
Please choose from the list provided.
Credit Card Expiration Date
Security Code on back of your card
Comments Or Messages Related To Your Payment