Norman Regional Health System

Online Bill Pay

Complete and submit the online Pre-Registration Form. If you have any questions, please call 405-307-2031.

Required indicates a required field.

Type of Service
Service/Procedure Information

(MM/DD/YYYY)

(Please enter "Dr." if First Name is unknown)

Patient Information
Please enter full legal name below
Patient Employment
(If unemployed, please type "none" in both Employer Name and Work Phone Fields)
Person to Notify
Financial Responsibility Information
Insurance Information
(If uninsured, please type "none" in the Insurance Company Name)
You may optionally upload an image of your insurance card. JPG, PNG, and GIF formats are allowed. Please limit the size of the file to 10MB.
Secondary Insurance Information
(If uninsured, please type "none" in the Insurance Company Name)