Hospital Bill Payment

Did you know?

Burgess has two family clinics to meet your healthcare needs.

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone
Email (required to receive receipt)
Location of Care Received (For Family Medicine Clinic, please call 712-423-1525 to make payment.)*
Account or Patient Number (found on the billing statement)*
Amount*
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name