Elliot Health System is a non-profit organization serving your healthcare needs since 1890.

Elliot Hospital Account Inquiry Form

Pay my Elliot Hospital bill:

 

This Form is for inquiries to be processed to Elliot Hospital only.

 

If you have any questions or concerns about your account with the Hospital please use the secure inquiry form provided here. Our Customer Service Representatives will review this information daily, and will follow up with you, if necessary, within two business days. If you would like to make a payment using your credit card, you may use the form at the bottom to do this as well.

Billing Dept Hours:
Monday -Friday 8:00am-8:00pm  
Phone: 1-866-425-3177

To pay your Elliot Hospital bill, click here.

PATIENT INFORMATION
---------* Indicates required field---------

*Last Name: *First Name: Middle: *Account Number:
Date of Service:
(MM/DD/YYYY)
Date of Birth:
(MM/DD/YYYY)

 

INQUIRER INFORMATION

Last Name: First: Daytime Phone:
Ext:
Evening Phone:
Ext:


*Address: *City: *State: *Zip:
Email: Message:

 

Please enter the security code in this box.

 

---This Form is NOT for procedures done at Elliot 1-Day Surgery Center---