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Whitman Hospital & Medical Clinics

Secure Payment Form

     
Account Number
First Name
Last Name
Address
City
State
Zip
Phone Number
Email Address

Required for receipt

Payment Amount
Name on Card
Card Number
Billing Zip
Expiration Date

MMYY

CVV2/CID

3 digit number on back of card

BEFORE MAKING A PAYMENT

PLEASE READ


Your WHITMAN HOSPITAL & MEDICAL CLINICS patient identification number can be found on your medical bill.

Please be sure to enter the account number located on your statement for which you are paying as you may have multiple account numbers with Whitman Hospital & Medical Clinics.

A verification receipt will be emailed to you upon completion of the transaction.

You may contact the Whitman Hospital & Medical Clinics by calling our Patient Financial Services office at:

(888) 292-8810 - Monday-Friday 8:00AM - 5:00PM

Thank you.

Privacy Policy: We are committed to protecting your privacy. We only collect information about the transactions you undertake including details of payment card. We will never pass your personal data to anyone else. The security of your personal information is very important to us. When you enter sensitive information (such as a credit card number) we encrypt that information using secure socket layer technology (SSL).