Online Patient Payment Center
Welcome to Monroe County Hospital Online Payment Center. You may make payments on your hospital bills here by credit card.
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 at (478) 994-2521 Monday thru Friday between 8:00 a.m. and 5:00 p.m.
You may make payments to Monroe County Hospital using your credit card information in the designated fields. All payments are via secure server. Thank you for allowing us to serve you.
Name Of Patient
Name of patient treated
Account number. (Should be located on your statement)
Name of Payor
Payor's name as it appears on credit card
Address where your credit card statement is mailed
City, State, Zip
Please include your city, state, and five digit zip code
Your E-Mail Address
Please provide a valid e-mail address.
Amount of Your Payment
Please specify how much you are paying. Please use dollars and cents (eg. 00.00)
Credit Card Type
Select type of credit card
Credit Card Number
Enter the 16 digit number just as it appears on card
Credit Card Expiration Date
Enter credit card expiration in MMYY format (Example: 0106)
Comments Or Messages Related To Your Payment