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Community Memorial Healthcare

Online Patient Payment Center

Welcome to the Online Payment Center. You may pay your hospital bills here by credit card or by check.
For your convenience please fill out the below payment form. All information will be kept secure and confidential. For more information you may call our business office during working hours.

You may make payments to the Hospital using your credit card information or by submitting your bank account routing number and checking account number in below fields. Please only supply one set of payment information: your credit card info or your online check information. All payments are via secure server. Thank you for allowing us to serve you.


* Name Of Patient
Name of Patient Treated.
  Invoice Number (optional)
Invoice Number. (Should Be Located On Your Bill, This is Optional)
* Name of Payor
Payor's Name on Credit Card or Checking Account.
* Billing Address
Address Where Your Credit Card or Bank Account Statements Are Mailed.
* City, State, Zip
Please Include Your City, State, and Five Digit Zip Code.
* Contact Telephone Number
Contact Telephone Number
* Amount of Your Payment
Please Specify How Much You Are Paying. Please Use Dollars and Cents.
* Your E-Mail Address
Please Provide An E-mail Address.
* Method of Payment?
Please Check One.
Credit Card     Online Check    
  Credit Card Type
Select If You Are Paying By Credit Card.
Visa     MasterCard     Discover    
  Credit Card Number
Input The 16 Digit Number Just As It Appears On Card.
  Credit Card Expiration Date
Example: 00/00
  Security Code
Security Code from the back of your credit card, unless it is an American Express card then use the 4 digit number on the front of the card.
  Name Of Your Bank
If Paying By Online Check, Please List The Local Bank Hosting Your Checking Account.
  Checking Account Routing Number
Found At The Bottom Of Your Check. Please Phone Your Bank If You Are Unsure.
  Checking Account Number
Found At The Bottom of Your Check. Please Phone Your Bank If You Are Unsure.
  Check Number
Make Sure You Note The Check Number Then Void The Check.
  Comments Or Messages Related To Your Payment