Online Bill Pay

Online Bill Pay

Payments may be made with:

“Terms & Conditions: Wichita Anesthesiology Chartered routinely collects Co-Pays, Co-Insurances, Self Pay Balances, Past Due Balances, and any Pre-Payment amounts prior to a scheduled procedure. Please allow 7-10 business days for your payment to be posted to your Wichita Anesthesiology Chartered Account”

“Refunds/Credits: Please contact the Wichita Anesthesiology Chartered business office if you have questions regarding a credit or refund due on your account”

Name*

Account number*

Amount

Payment Information

Cardholder name*:

Card number*:

Expiration date*:

-

CVV2 Code*

:

Billing Address

First Name:*

Last Name:*

Address Line 1:*

Address Line 2:

City:*

State:*

Country:*

Zip:*

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