Pay your bill form - Community Memorial Hospital

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Pay Your Bill

You can pay your bill using the form below:
Hidden
IP Address
Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Patient Account Number*
Amount to Pay*

If your statement has a Prompt Pay discount offer, you can deduct 10% from your payment.
Total
$0.00
Special Instructions
Is there anything we should know about this payment?
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
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Comments
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Pay Your Bill