ASC Anesthesia Associates
Secure Patient Payment Portal
Patient Information
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Payment Details
Chart Number
*
Payment Amount
*
Payment Summary
Patient:
-
Chart Number:
-
Payment Amount:
$0.00
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Pay with Stripe
Secure checkout with credit/debit cards
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You'll be redirected to our secure payment partner to complete your transaction. We never store your payment information on our servers.