Payments

You may securely make a payment here for your Western Surgical or Western Bariatric Institute account. Upon approval, a receipt will be emailed to you and your payment will be posted to your account within 2 business days. No Refunds on Account Payments, except in the case of overpayment, then a credit will be issued to your Credit Card. Information is used expressly for payment processing only.

Note: All fields are required!

Patient Information
Name*
First Last
Account #*
Phone #*
Credit Card Billing Information
Name*
First Last
Billing Address*
Street Address City State / Province / Region ZIP / Postal Code
Email Address*
Payment Amount*
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

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