Island Hospital
 
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Pay Your Bill
Patient Information
First Name
Last Name

Address

City
State
Zip Code

Email
Phone


Account # (i.e. F01234567,
ST0123456789PF or ST0123456789IS)  
Payment Amount Comments

Total Payment:
 

Billing Information

Same as Patient Information

First Name
Last Name

Address

City
State
Zip Code

Email
Phone

Type
 
Credit Card Number
numbers only - no dashes or spaces
Exp Date
 /   
CVC


[Currently In Testing Mode - Do not use actual credit card information]