Piedmont Health Group: Your Community Provider for Better Health Care*

Payments

You may use this page to make a payment on an account that you are responsible for. Just fill out the form below and press Submit Payment. PHG staff will then process your payment, notify you of the payment status, and they will update their records.

* Required fields

Name on Account: 
First: *
Middle:
Last: *
Physician: *

Account Number:

Payment Type: *
Credit Card Number: *
Expiration Date: *
Security Code:
What is this?
*
Amount of Payment: *

Contact Information
(concerning this payment):
 
Phone: *
Email: *
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