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Goodland Regional Medical Center

Online Patient Payment Center

Welcome to Goodland Regional Medical Center and Goodland Family Health Center Online Payment Center. You may pay your hospital and/or clinic bills here by credit card or debit 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 at (785)890-6078 Monday- Friday 8:30 A.M. to 4:30 P.M.

You may make payments to Goodland Regional Medical Center using your credit card or checking account information. All payments are via secure server. Thank you for allowing us to serve you.
* Name Of Patient
Name of Patient Treated.
Account Information
Patient account number. This is a 11 digit number located on your statement and/or letter. (If no account number is supplied, we will apply the payment to the oldest date of service.) You can list one or more account numbers here.
* Patient Account 1
* Amount 1 $
  Patient Account 2
  Amount 2 $
  Patient Account 3
  Amount 3 $
  Patient Account 4
  Amount 4 $
  Patient Account 5
  Amount 5 $
* Your E-Mail Address
Please Provide An E-mail Address.
* Please designate what type of account you are paying:
if both please provide comments below
  Comments Or Messages Related To Your Payment
Payment Information
* Cardholder Name
Payor's Name on Credit Card or Bank Statements
* 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