Pay Your Bill Online

Use our secure form to pay your bill online. If you have any questions or concerns about your bill, you can contact our Patient Financial Services.

National Jewish Health believes in providing access to care for all patients, including those of limited means. View our Financial Assistance Policy.

Patient Information
First Name*
Last Name*
Patient Account Numbers
Medical Record Number (999-99-99)
Email*
Address 1*
Address 2
Country
City*
State*
ZIP* (99999 or 9999-9999)
Home/Mobile Number*
Work Number
Amount* (9.99)
Payment Type
Billing Information
 Patient Information
First Name*
Last Name*
Business Name
Address 1*
Address 2
Country*
City*
State*
ZIP* (99999 or 9999-9999)
Credit Card Info
Card Type*
Card Number*
CVV2*
Expiration*
Electronic Check
By marking this checkbox, I am authorizing the entered bank account to be charged for the payment amount entered. As payor, I am authorized to conduct transactions from the entered bank account and all information entered is valid. This payment authorization will remain in effect unless I notify its cancellation by sending written notice.
Rounting Number*
Account Number*
Account Type*

Bank Name*
Name on Account*
 Security code