Surgery Center Payment Form

Payment Instructions

  1. To process your payment successfully we will need some information from you.
  2. If you know your account number please enter it below, or enter your date of birth.
  3. Enter the amount of the payment you would like to make on your account.
  4. Click the "Continue" button to open the secure payment information form.
  5. Once payment has been entered and submitted, you will receive an email confirmation.
Account #
OR
Birthdate

 Amount $

Payment Confirmation

Name: Customer Name
Date: 11/20/2015
Account #:  
Date of Birth:
Payment Amount: $ 0.00

Thank you for your Chu Vision Institute payment.

Sincerely,

The Chu Vision Team


Payment Error

An error occurred while processing your payment request. Please try again at a later time. If this error persists please call our office for additional assistance.