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Helen Keller Hospital

Online Patient Payment Center

Welcome to the Online Payment Center. You may pay your Helen Keller Hospital or Red Bay hospital bill here by credit/debit.
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 in below fields. All payments are via secure server. Thank you for allowing us to serve you.
* I am paying my bill for:
* Name Of Patient
Name of Patient Treated.
* Patient Account Number
* Name of Payor
Payor's Name on Credit Card or Debit Account.
* Phone Number
This will ONLY be used to contact you about your payment, if necessary.
* Your E-Mail Address
Please Provide An E-mail Address.
  Comments Or Messages Related To Your Payment
Billing Information
* Credit Card Type
Select If You Are Paying By Credit Card.
Visa     MasterCard     Discover     American Express    
* Amount of Payment
Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)
$
* Card Number
* Expiration Date
* Card Code Verification Number
The three digit number on the back of your card. (Four digit code on the front of American Express.)
* Billing Postal or Street Address
* Billing City
* Billing State
* Billing Zip Code
5 digit zip code