Pay Your Bill Online

Please use the form below to make a payment to Penn Highlands Elk, or Penn Highlands Pinecrest Manor.

Statement of Account Information

Location:

Penn Highlands Elk
Penn Highlands Pinecrest Manor
1
Patient First Name:
Patient Last Name:
Where is this on my bill?
2
Account Number:
Where is this on my bill?
3
Date of Service:
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Payment Amount:
(Amount you are going to pay)

Billing Information

First Name:
Last Name:
Email:
Address:
Address Line 2:
City:
State:
Zip:
Phone:

Credit Card Information

Name on Card:
Card Number:
Expiration Date:
CVV Number:
What is a CVV number?

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