Name: Make a Payment
SKU: 155
Availability: InStock

Home - Make a Payment

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Name On Statement *

Patient Name *

Bill From *

Admission Number

If the Admission Number is unknown, you may enter your Account Number or the Date of Service. If the field is left blank, the payment will be applied to the oldest Date of Service

Payment Amount *

Payor’s Email Address *

Payor’s Phone Number *

Comments

Category: Bill Payment Tag: Payment

Description

Description

For your convenience, you can now pay your clinic and hospital bills online. This service allows you to pay your bills quickly & securely by filling out the form below.

Make a Payment

Description

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