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Lillian M. Hudspeth Memorial Hospital

Online Patient Payment Center

Welcome to the Online Payment Center. You may pay your hospital bills here by credit card using this form.
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
  Comments Or Messages Related To Your Payment
  Credit Card Type
Select If You Are Paying By Credit Card.
Visa     MasterCard     American Express     Discover    
* Amount of Payment
Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)
$
* Card Number
* Expiration Date
* Cardholder First Name
The first name of the account holder as it appears on the credit card.
* Cardholder Last Name
The last name of the account holder as it appears on the credit card.
* Card Code Verification Number
The three digit number on the back of your card. (Four digit code on the front of American Express.)
* Email Address
* Billing Postal or Street Address
* Billing City
* Billing State
* Billing Zip Code
5 digit zip code
* Contact Phone Number
Please provide a phone number where we may reach you regarding this payment