Employee bonus repayments may be made using the secure form below.


FULL Name: *
Date of Birth: *
Last 4 digits of your Social Security Number: *
Phone: *
Email: *
Repayment Amount:
Do not enter a dollar sign.

Please TRIPLE check the amount entered above for accuracy. Overpayments will cause funds to become reserved on your card and it could take several business days for a refund to process.


Credit card number:

Exp Month/Year/

CVV (3 digit verification number on card):




Please only press the payment link/button below *ONCE* and allow time to process!!!
Pressing a second time MAY cause a double charge!

Pikeville Medical Center