Pay Your Bill

Do you need to pay a bill for Cullman Regional Medical Group?

First Name*
Last Name*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
Payment Type*
- Credit Card
- eCheck
Credit Card*
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Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Bank Name*
Bank Routing Number*
Bank Account Number*
Bank Account Type*
Bank Account Name*
Select the Type of Bill to Pay*
- Ambulance Service
- CPAP Care Center
- Home Care Services
- Hospital
- Physician Visit
- Pre-Registration
Payment Amount*
Patient's Account or Statement Number (If paying for CPR Card, please type CPR in box below)*
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