Berkshire Health Systems - Online Bill Payment Portal

Please note: If you are paying for more than one visit at Berkshire Health Systems you must list each visit separately, using the appropriate account number and the amount you are paying on each account.

Required fields are marked with an (*).

Account Number	Amount to Pay
1.	$
2.	$
3.	$
4.	$
5.	$
Total Payment	$
* Patient Name:
* Credit Card Number:
* Expiration Date:
* CCV Code:
* Card Holder First Name:
* Card Holder Last Name:
* Card Street Address:
* Card Holder City:
* Card Holder State:
* Card Holder Zip Code:
* Contact Phone:

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