Medical Staff Membership Fees

Medical Staff Services is pleased to offer a credit card payment option for Medical Staff application fees, annual Medical Staff dues, and other fees assessed as part of Medical Staff membership obligations. If you have any comments or questions, please contact medicalstaffservices@midhosp.org or call (860) 358-6105. Thank you!

*Please Note For Multiple Payments

If you are submitting a payment on behalf of multiple Medical Staff members, please include your information in the "Medical Staff Member Information" field and email medicalstaffservices@midhosp.org with complete information related to the specific membership fees being paid, including Medical Staff name, purpose of payment, and amount.

All fields are required unless otherwise noted.

Medical Staff Member Information*
First name is required
Last name is required
(ex. Jr., III)

Billing Address
Billing address is required
Billing city is required
Billing state/province is required
Billing state/province is required
Billing zip/postal code is required
Billing country is required
Billing phone is required
Billing email is required
A confirmation email will be sent to this email address.

Payment Details
Please select the payment purpose
Please specify the payment purpose
Please indicate the amount you wish to pay
.00
Please indicate the amount you wish to pay, minimum $5.
Must be a valid credit card number
Accepted cards
Expiration date is required
mm/yyyy
Security code is required
Card Verification Value (CVV)