Pay Bill

Our goal is to make it easy for you to take care of your medical bill with the Urgency Room.

Please note: All email correspondence is communicated through secure email. Please be sure to check spam and junk folders if you have not received a response from us. We will respond to your message within two business days.

Questions?

Requestor Name *

Email Address *

Patient Name *

Account Number *

Patient Date of Birth * mm/dd/yyyy

Date of Service * mm/dd/yyyy

Patient Address *

Relationship to Patient *

Self
Spouse
Parent/Guarantor
Power of Attorney
Other

How May We Help You * Please provide detail regarding your request. All messages will be responded to via secure messaging.

Security Check

Patient privacy is important to us. Authorization from the patient is required on all requests when the patient is 18 or older on the date of service.

Review our FAQs for additional information about the UR.

If you have any questions about your bill please contact us.
Phone: 952-857-0644

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