Beaver Dam Community Hospital
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Thursday 7/24/2008 12:22:20 PM

Beaver Dam Community Hospital's online payment service allows you to securely submit payment for your hospital bill in the most efficient manner possible - online with your credit card. Currently we accept MasterCard, Discover, and Visa.
When you have completed the form, click Submit Payment and print a copy for your records. Your payment will normally be processed withing 24 hours of submission.

If you have any questions, contact the Business Office at (920) 887-4000 or you can send us an email. Our office is open Monday thru Friday 8:00 AM - 4:30 PM.
(* indicates required field)
Patient Account Information
* Patient Name:  (First)    (Last)
* Daytime Phone Number: ()  -

Payments made to a guarantor number will be applied to oldest account, enter the guarantor number and amount paid in the spaces provided below [ HELP ME FIND GUARANTOR NUMBER ]
Guarantor Number: Amount To Pay:  (xxxx.xx)

If you want to make payment to specific account(s), please list accounts and payments below.
[ HELP ME FIND ACCOUNT NUMBERS ]
Account Number: Amount To Pay: $ (xxxx.xx)
Account Number: Amount To Pay: $ (xxxx.xx)
Account Number: Amount To Pay: $ (xxxx.xx)
Account Number: Amount To Pay: $ (xxxx.xx)
Account Number: Amount To Pay: $ (xxxx.xx)

 

 Total Paid: $ 
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