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 during working hours.
You may make payments to the Hospital submitting your credit card information in below fields.
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. (Should Be Located On Your Bill)
Your E-Mail Address
Please Provide An E-mail Address.
Comments Or Messages Related To Your Payment
Name on Credit Card.
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.
Amount of Payment
Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)