Western Anesthesiology Associates, Inc. 
Online Payment Center

(We accept Visa, Mastercard or Discover credit card payments)

Please fill out the payment form below. All information will be kept secure and confidential.
Enter the information as shown on your bill. Partial payments are acceptable.

For more information, or if you encounter any problems, you may call our business office
at 636-386-9224 during working hours (Monday - Friday, 8:00am - 5:00pm CST).

Refund Policy:
You are entitled to a refund in the event of an overpayment to your self pay portion.

Patient Information

Please fill in the required information

Patient Account Number
Patient's Name
Payer's Relation to Patient (spouse, parent, guardian, etc)
Payment Amount  $ ex. 50.00

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Revised: 05/11/16

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