Information Technology Security Incident

Click here for a notice about a data privacy incident at Capital Health.

Online Bill Payment Form

Thank you for using our secure online bill payment form! This is a two-step form that requires you to first complete your personal information below. After you click the link at the bottom, you will be taken to a second form to complete your payment information. Once you complete the second form, you're all set! If you do not complete the second form, your payment will not be received.

Our secure online bill payment system only accepts Mastercard, American Express, Discover, and Visa credit cards. If you want to pay your bill using a flexible spending account card, please call 609-394-6023 to make your payment over the phone or e-mail [email protected] and someone will call you at your convenience.

Patient Information

Required information is indicated by a red * before the label

Patient Address

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.