Online Patient Payment Center
Welcome to the Online Payment Center. You may pay your hospital bills here by credit/debit 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 970-675-5011 Monday through Friday 7 am to 5 pm.
You may make payments to the Hospital using your credit card information in below
Thank you for allowing us to serve you.
Name Of Patient
Name of Patient Treated.
Account Number - usually in the top left hand corner of your bill.
Billing Name on Credit Card.
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
Comments Or Messages Related To Your Payment