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Delta County Memorial Hospital

Online Patient Payment Center

Welcome to Delta County Memorial Hospital Online Payment Center. You may pay your hospital bills here by credit card.
For your convenience please fill out the below payment form. All information will be kept secure and confidential. For more information you may call our business office during working hours.

You may make payments to the Hospital using your credit card information or by submitting your bank account routing number and checking account number in below fields. Please only supply one set of payment information: your credit card info or your online check information. All payments are via secure server. Thank you for allowing us to serve you.

Refund Policy:
NO REFUNDS, NO EXCEPTIONS.

Privacy Policy:
DCMH Privacy Policy
* Name Of Patient
Name of Patient Treated.
* Account Number
* Name of Payor
Payor's Name on Credit Card or Checking Account.
* Billing Address
Address Where Your Credit Card or Bank Account Statements Are Mailed.
* City, State, Zip
Please Include Your City, State, and Five Digit Zip Code.
* Your E-Mail Address
Please Provide An E-mail Address.
Payment Details
Complete all fields below to ensure a no-hassle process.
  Credit Card Type
Select If You Are Paying By Credit Card.
Visa     MasterCard     Discover     American Express    
* Cardholder First Name
The first name of the account holder as it appears on the credit card.
* Cardholder Last Name
The last name of the account holder as it appears on the credit card.
* Amount of Payment
Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)
$
* Card Number
* Expiration Date
* 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
* Billing City
* Billing State
* Billing Zip Code
5 digit zip code