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Purcell Municipal Hospital

Online Patient Payment Center

Welcome to the Online Payment Center. You may pay 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 8:00am to 4:30pm Monday thru Friday 405-527-2242.

You may make payments to the Hospital using your credit card information. All payments are via secure server. Thank you for allowing us to serve you.


* Name Of Patient
Name of Patient Treated.
* Patient Account Number
Patient Account Number. (Should Be Located On Your Bill.)
* Your E-Mail Address
Please Provide An E-mail Address.
  Comments Or Messages Related To Your Payment
Billing Information
* Billing Name
As it appears on credit card
* 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