Baylor Health Care SystemAbout B
 
Need something? Call us: 1.800.4BAYLOR(1.800.422.9567)
Text Size:

Patient Billing Help 

Please complete the form below.

Required information is marked with " * ".
Nature of request



Choose a Baylor Facility  
First name  
Last name  
Account Number:  
Patient's Date of Birth (mm/dd/yyyy)     
Daytime Phone Number    
Email Address    
Message:  
Disclaimer:
"I Acknowledge that I have requested Baylor to transmit certain personal financial information to me via e-mail. I understand that, although Baylor has taken appropriate precautions to protect against unauthorized access to electronically-transmitted information, it is possible that e-mail transmission may be intercepted or accessed by individuals other than the intended recipient. Nevertheless, I authorize Baylor to transfer the requested information to me via e-mail with the understanding that Baylor is not responsible for, and cannot guarantee, the privacy of the transmitted information following delivery to me. Furthermore, I represent that I am the patient or the patient's authorized reporesentative, for whom such information has been requested."