Home Patients Online Bill Pay

Online Bill Pay

Please complete the form below to pay your HOMELINK bill through a secure online payment gateway. Once you submit your payment, you will be emailed a receipt of your transaction to keep for your records.

Account Information
First Name
Middle Name
Last Name
Address
Address 2
Zip
City
State
Phone
Email
Company Name
Billing information is different than account information.

Billing Information
First Name
Last Name
Address
Zip
City
State

Payment Information
Account Number (optional)
Invoice
Payment Amount
PAYMENT TOTAL
Card Type

Select a Card Type - Visa, MasterCard, Discover
Card Number
Expiration Date /
Security Code
I would like to set up a recurring payment.
- Recurring Payment Contact Information
- Please provide us the following information to get in touch with you about setting up a recurring payment.
- Email Address
- Phone
I agree to pay by the above method and have read and agreed to the terms and conditions.

Refund Policy
HOMELINK will issue refunds within 30 days on overpayments of your patient portion. If you feel an additional refund is needed for your products or services please contact HOMELINK at 888-820-0355 ext 3137 and we will personally work through your refund request with you.

Call (800) 482-1993

Online Bill Pay

Account Information

Billing Information

Payment Information

PAYMENT TOTAL

Card Type

Recurring Payment Contact Information

Please provide us the following information to get in touch with you about setting up a recurring payment.

Call (800) 482-1993