Methodist Hospitals | Hospital Billing

Visitors & Patients

Introduction HIPAA Patient Rights Advance Directives Preparing for Stay Medicines and You Patient Safety Preventing Infection Central Billing Office Your Rights & Responsibilities Insurance/Self Pay If You Don't Have Insurance General Payment Policies Frequently Asked Questions

Central Billing Office

Credit Card Payment Form

Patient Account Number:

Patient Name:

Guarantor Name:

Payment Amount:

Phone Number:

Please enter your credit card information below

Card Holder's Last Name:

Card Holder's First Name:

Card Holder's Address 1:

Address 2:

City:

State:

(Please select "Other" if you reside outside the U.S.)

Zip:

Credit Card Type:

Credit Card Number:

Verification Number:

Expiration Date:

(a receipt will be mailed to you)