Your browser does not support JavaScript!
This form cannot automatically check that you have submitted all of the required fields without JavaScript.
Please be sure to submit all required fields (marked with stars).

Northern Cochise Community Hospital

Online Patient Payment Center

Welcome to Northern Cochise Community Hospital Online Payment Center.

You may pay your hospital bills here by credit card/debit card.
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 Monday through Friday 8 am to 5 pm at 520-384-3541.

You may make payments to Northern Cochise Community 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.
* Patient Account Number
Account Number Is Located On The Left Side of Your Bill.
* Billing Name
Name as it appears on the front of your card.
* Billing Address
Address Where Your Credit Card Statements Are Mailed.
* City, State, Zip
Please Include Your City, State, and Five Digit Zip Code.
* Your E-Mail Address
Please Provide An E-mail Address.
* Amount of Your Payment
Please Specify How Much You Are Paying. Please Use Dollars and Cents.
* Credit Card Type
Select If You Are Paying By Credit Card.
* Credit Card Number
Input The 16 Digit Number Just As It Appears On Card.
* Credit Card Expiration Date
mm/yy
  Comments Or Messages Related To Your Payment