Patient Financial Services Inquiry

Form Description

Have a question about your billing from PeaceHealth? Use this form to send an e-mail to PeaceHealth Patient Financial Services for any hospital or medical group related business. If you have any questions about this form, please contact us.

Directions

* This form is not secure. Please do not include information such as Social Security number, credit card numbers, or confidential medical information.

* This form is not to be used for medical advice, diagnosis or treatment. If you think you have an emergency medical condition, call 911 or go to the nearest hospital.
Questions marked with a red * require a response.