Online Patient Payment Center
Welcome to ProMedica Coldwater Regional Hospital Online Payment Center. You may pay your hospital bills here by credit card or debit card.
For your convenience please fill out the payment form below. All information will be kept secure and confidential. For more information you may call our business office at 517-279-5308 between 8 a.m. and 4:30 p.m.
PAYMENT CAN ONLY BE APPLIED TO ONE PATIENT ACCOUNT PER TRANSACTION.
You may make payments to ProMedica Coldwater Regional Hospital using your credit card information in the fields below.
All payments are via secure server. No financial or personal data is stored on the server at any time. Thank you for allowing us to serve you.
Name of Patient
Name of patient treated
Date of Birth
If paying more than one account, please list each account and amount to be credited. Make sure your amounts total to the Payment Amount listed under billing information.
Patient Account #1
Patient account number (located on bill)
Amount to credit to patient account #1
Patient Account #2
Amount to credit to patient account #2
Patient Account #3
Amount to credit to patient account #3
Patient Account #4
Amount to credit to patient account #4
Patient Account #5
Amount to credit to patient account #5
make sure your amounts total to the Payment Amount listed below.
Name as it appears on credit or debit card
Phone Number (required)
Please enter area code before number
Comments Or Messages Related To Your Payment
Amount of Payment
Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)
Card Code Verification Number
The three digit number on the back of your card. (Four digit code on the front of American Express.)
Billing Postal or Street Address
District Of Columbia
Billing Zip Code
5 digit zip code