Payment - The Surgery Center

Make an online payment to The Surgery Center of Oxford, Alabama, using the form below, or call us at (256) 241-2230.

"*" indicates required fields

Patient Name

First Name*

Middle Name

Last Name*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Date of Birth*

Account Number*

Payment Amount*

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Total

Name

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