Athens Regional Health System
706.475.7000

Home Health Payments

Please use this form to pay your bill with Athens Regional Home Health or Athens Regional Home Infusion.

* Indicates required information
Select if payment is for Athens Regional Home Health or Athens Regional Home Infusion * 
Patient Full Name * 
Patient ID # (usually 4 digit number - without the leading zeros) * 
Amount You Want to Pay Now * 
Card Type  * 
Name on Card * 
Card Number * 
Expiration Date (MMYY) *  Month Year
Signature Code (last three numbers on back of card) * 
Contact Phone Number * 
Contact E-mail Address 
 
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