Account Information Request Form

Meridian Health Account Info Request Form

If you would like to contact the Patient Accounts Department for questions or concerns. Please take a few minutes to fill out the contact form below and a representative will contact you as quickly as possible.

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Patient Information
First Name
MI
Last Name
E-Mail Address
Patient Account Number
(please, no spaces or dashes)
  if you don't know the account number
please provide the following –
Date of Birth
(mm/dd/yyyy)
Date of Service
(mm/dd/yyyy)
Facility where you
were treated?
Jersey Shore University Medical Center
Ocean Medical Center
Riverview Medical Center Bayshore Community Hospital Southern Ocean Medical Center

How Can We Help You?

Account Balance? (You will receive an e-mail with the balance within 2 business days.)

A Copy of your Bill? (When requested, Patients Accounts will respond by mailing the itemized bill to the customer by traditional mail.)

Payment Arrangements? (When requested, a customer service representative will call you to set up a payment arrangement.) Please note: Patient Accounts business hours are: Monday to Friday 8:30am to 5:00pm.

Phone Number

New Address?

Street Address
City
State
Zip
Any billing issues or other questions?

 

Submit

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