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Patients & Visitors Hospital Billing Billing Pages
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General Question

Central Business Office
Customer Service Department
(216) 844-8299, toll free at 1-800-859-5906
Hours: M-F 9:00 a.m.-3:30p.m.

Please feel free to contact us if you have a problem or a question regarding your hospital services account or utilize the
"free form question" section at the bottom of this page to submit a request not identified in Common Customer Requests/Forms.


Please, complete all fields marked with an asterisk (*), as they are required.
* Patient First Name:
 M.I.:
 * Patient Last Name:
* Requestor First Name:
 M.I.:
 * Requestor Last Name:
* Relation to Patient:
* Services were rendered at:
* Account Number:
* From Date of Service:
Calendar
To Date of Service:
Calendar
* Address

* City:
 * State:
 * ZIP:
* Country:
* Question:

Phone Number:
 Alternate Phone Number:
Email:


Additional Comments: